MyMedR

Abdullah S

J Hand Surg Glob Online, 2022 Nov;4(6):384.

PMID: 36425364 DOI: 10.1016/j.jhsg.2022.10.008

Fulltext End-to-side nerve transfer in neuropathic pain post brachial plexus injury

Nur Dina, A., Shalimar, A.

JUMMEC, 2013;21(2):71-73.

MyJurnal

We report a case of a 59-year-old gentleman with complete left brachial plexus injury. He presented with
chronic pain over the dorsum of his left hand since the injury eight years ago. Medical treatment had been
optimised but the pain still persist. End-to-side nerve transfer was done involving superficial sensory radial
nerve and median nerve to alleviate the pain. The surgery was considered successful as the patient claimed
that the pain score had reduced a few weeks postoperatively. However, there was no sensory recovery and
functionally no improvement was observed.

Fulltext A Palmar Lipoma with Median and Ulnar Nerve Compressive Symptoms

Azwa, N., Shalimar, A., Jamari, S.

Malays Orthop J, 2007;1(2):33-35.

MyJurnal

Although lipoma is common in the upper limbs, it rarely occurs in the palm, and usually does not compress the surrounding structures. Here, we report a patient presenting with compressive neuropathy of the ulna and median nerves secondary to a palmar lipoma. Surgical excision led to full neurological recovery.

Fulltext Complete Brachial Plexus Injury - An Amputation Dilemma. A Case Report

Choong C, Shalimar A, Jamari S

Malays Orthop J, 2015 Nov;9(3):52-54.

PMID: 28611911 MyJurnal DOI: 10.5704/MOJ.1511.017

Brachial plexus injuries with intact yet flail limb presents with problems of persistent neuropathic pain and recurrent shoulder dislocations, that render the flail limb a damn nuisance. As treating surgeons, we are faced with the dilemma of offering treatment options, bearing in mind the patient's functional status and expectations. We present a case of a 55-year old housewife with complete brachial plexus injury begging for surgical amputation of her flail limb, 6 years post-injury. Here we discuss the outcome of transhumeral amputation and the possibility of offering early rather than delayed amputations in this group of patients.

Report of the 10(th) Asia-Pacific Federation of Societies for Surgery of the Hand Congress (Organising Chair and Scientific Chair)

A RS, Abdullah S

J Hand Surg Asian Pac Vol, 2016 10;21(3):439-43.

PMID: 27595972 DOI: 10.1142/S2424835516970018

A report on the 10(th) Asia-Pacific Federation of Societies for the Surgery of the Hand and 6(th) Asia-Pacific Federation of Societies for Hand Therapists is submitted detailing the numbers of attendees participating, papers presented and support received as well the some of the challenges faced and how best to overcome them from the local conference chair and scientific chair point of view.

WALANT technique for percutaneous pinning of distal radioulnar joint

Azhar S, Abdullah S, Soh E

J Hand Surg Eur Vol, 2023 Mar;48(3):279-281.

PMID: 36691295 DOI: 10.1177/17531934221148115

Glomus tumor in the second toe: a clinical insight

Sapuan J, Paul AG, Abdullah S

J Foot Ankle Surg, 2008;47(5):483-6.

PMID: 18725132 DOI: 10.1053/j.jfas.2008.05.008

Glomus tumors are rare benign tumors commonly occurring in the digits of the hand. Surprisingly, considering the fingertips are of a similar make-up to the toes, there have been few reports of glomus tumor in the toes. The present case highlights a glomus tumor observed in the right second toe of a 56-year-old Indian female who presented with the classical triad of spontaneous pain, cold hypersensitivity, and pressure tenderness. There was a delay in diagnosis for approximately 18 years by various general practitioners who were not aware of the rare presentation of the glomus tumor. The tumor, which measured 5 x 3 mm, was excised from the nail bed of the toe. Histopathological inspection confirmed the diagnosis of glomus tumor. We believe that reporting this rare case may make clinicians more aware of this unusual diagnosis.

Fulltext Congenital insensitivity to pain with anhydrosis in a Malaysian family: a genetic analysis

Shalimar A, Sharaf I, Farah Wahida I, Ruszymah BH

J Orthop Surg (Hong Kong), 2007 Dec;15(3):357-60.

PMID: 18162686 DOI: 10.1177/230949900701500323

A Malaysian family with congenital insensitivity to pain with anhydrosis was diagnosed based on clinical symptoms of chronic ulcers, joint deformities, malunited fractures, anhydrosis, and learning disabilities. We detected a compound heterozygous mutation in exon 16: V709L from the mother and G718S from the father. Two novel mutations were identified: at amino acid 709, a change of G to C at nucleotide 2209 (approximately 2209G to C) causing a valine to leucine substitution (V709L), and at amino acid 718, a change of G to A at nucleotide 2236 (approximately 2236G to A) causing a glycine to serine substitution (G718S). Polymorphisms identified were at nucleotides approximately 2113G to C and approximately 2176T to C.

Hand Surgery in Malaysia

Ahmad TS, Ahmad AA, Abdullah S

J Hand Microsurg, 2021 Jan;13(1):21-26.

PMID: 33707919 DOI: 10.1055/s-0040-1721942

We have all heard the old aphorism, "Necessity is the mother of invention." While the provenance of the proverb is uncertain, its truth is not in doubt. This is true for the development of hand surgery in Malaysia. As part of the management for leprosy, patients with high ulnar nerve palsies were managed by the pioneers of hand surgery in Malaysia. They did tendon transfers to improve the quality of life of these patients. Since then, hand surgery in Malaysia have grown leaps and bounds. From a small humble beginning in the suburb of Sungai Buloh to organizing the 10th Congress of Asian Pacific Federation of Societies for Surgery of the Hand, hand surgery in Malaysia will only get better with time.

Splinting after Carpal Tunnel Release: Does it really Matter?

Shalimar A, Nor-Hazla MH, Arifaizad A, Jamari S

Malays Orthop J, 2015 Jul;9(2):41-46.

PMID: 28435609 MyJurnal DOI: 10.5704/MOJ.1507.011

Splinting of the wrist after carpal tunnel release (CTR) has been practised by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR have had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting.

METHODS: All 30 of our patients underwent a standardized limited open CTR by a designated surgeon. Post operatively, they were randomized into a splinted (n=16) and a nonsplinted (n=14) group. The splint was kept for a week. Patients were reviewed at regular intervals of one week, two months and six months. At each follow up, these patients were clinically assessed for the following outcome measures: VAS (visual analogue score), 2PD (two-point discrimination), pinch grip, grip, Abductor Pollicis Brevis (APB)) power and completion of the Boston questionnaire.

RESULTS: All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up.

CONCLUSION: We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release.

A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline

Mohd Rashid MZ, Sapuan J, Abdullah S

J Orthop Surg (Hong Kong), 2019 3 12;27(1):2309499019833002.

PMID: 30852960 DOI: 10.1177/2309499019833002

BACKGROUND:: Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT.

METHODS:: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded.

RESULTS:: Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference.

CONCLUSION:: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.

Fulltext Mistaking a Tumour for an Infection - Acrometastasis of the Finger from Endocervical Adenosquamous Carcinoma: A Case Report

Yong AS, Gill PS, Shalimar A, Sapuan J

Malays Orthop J, 2021 Nov;15(3):115-117.

PMID: 34966504 DOI: 10.5704/MOJ.2111.017

Acrometastasis is rare with a very low incidence of all bone metastasis. It can present with swelling, pain and warmth with erythema that may mimic an infection especially in the distal phalanx. Due to its rarity and subtle clinical presentation, it can be misdiagnosed as an infection causing the treatment to be delayed. We report a 42-year-old female with an acrometastasis to the distal phalanx of the left middle finger which we mistook as an infection thus delaying her treatment. It was a terminal presentation of her endocervical adenosquamous carcinoma. We would like to highlight that acrometastasis has an indistinct presentation and in cases where the lesion does not respond to treatment, acrometastasis should be included as one of the differential diagnoses. Thus, physicians need to have a high level of suspicion in patients with a primary malignant tumour.

Fulltext Wide Awake Local Anesthesia No Tourniquet Forearm Triple Tendon Transfer in Radial Nerve Palsy

Abdullah S, Ahmad AA, Lalonde D

Plast Reconstr Surg Glob Open, 2020 Aug;8(8):e3023.

PMID: 32983779 DOI: 10.1097/GOX.0000000000003023

Tendon transfer for radial nerve palsy is a common procedure done under general anesthesia. We describe a surgical technique of triple tendon transfer with wide awake local anesthesia no tourniquet (WALANT). We transfer flexor carpi radialis to extensor digitorum communis, palmaris longus to extensor pollicis longus, and pronator teres to extensor carpi radialis brevis. This is commonly known as the Brand transfer. Our anesthetic or WALANT solution consists of up to 200 mL of 1:400,000 epinephrine, 0.25% lidocaine buffered with sodium bicarbonate. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively extend their fingers, thumb, and wrist during the surgery and making adjustments before we close the wound. In our experience, there is no need of brain retraining because a patient is able to immediately use the flexor muscles to perform extension movements. WALANT is a safe and viable option for radial nerve tendon transfers.

Fulltext Adhesions as an uncommon complication of k-wiring in paediatric phalangeal fractures

Nanchappan S., Parminder G.S., Nur Azuatul, A.K., Tan, J.A., Ahmad Suparno, B., Jamari, S., et al.

Medicine & Health, 2019;14(1):203-208.

MyJurnal

Paediatric hand fractures are common and prompt management is mandatory to achieve a good functional outcome. However many fail to realize that treating a fracture does not only involve bones but the soft tissues, as well. K-wiring itself can be difficult with multiple attempts inadvertently injuring the flexor or extensor tendons and resulting in adhesions. We highlight this possible complication of K-wiring which we believe is under reported due to the perception that K-wiring is a simple procedure. We present a case of a 9-year-old child, who sustained a closed displaced fracture of the base of the proximal phalanx (Salter Harris type 2) of the left index finger. He underwent percutaneous K-wiring but was complicated with severe adhesions of the flexor digitorum profundus (FDP) and flexor digitorum superficialis tendons (FDS). He was unable to flex the proximal and distal interphalangeal joints of the affected finger. We subsequently performed tendon adhesiolysis twice together with A2 pulley reconstruction, to restore movement of the finger. K-wiring of the fingers are not just simple bony procedures but also involve soft tissue components which can be prone to adhesions.

Fulltext Anatomical variations of the lumbrical muscles causing carpal tunnel syndrome

Benny, E., Parminder, G.S., Nur Azuatul, A.K., Tan, J.A., Ahmad Suparno, B., JamarI, S., et al.

Medicine & Health, 2019;14(1):197-202.

MyJurnal

Many anatomical variations exist in and around the carpal tunnel. However, symptomatic anomalies causing carpal tunnel syndrome is rare. Additionally, carpal tunnel surgery is considered a simple operation commonly done by junior surgeons who are usually unaware of variations resulting in unfavorable surgical outcomes. We highlight a case of lumbrical muscle variation causing carpal tunnel syndrome. A 73-year-old male presented with numbness and pain of both hands associated with abnormal fullness over both wrists and distal forearms. Initially the right hand was numb and subsequently a year later, the left hand became numb. Physical examination was positive for Durkan, Phalen and Tinel signs at the carpal tunnel. Magnetic Resonance Imaging (MRI) showed abnormal muscle tissues in the carpal tunnel. During the carpal tunnel release and exploratory surgery, we noted an abnormally proximal origin of the lumbrical muscles in the forearm rather than the typical palmar origin. He also had lumbrical muscle hypertrophy in the left side. These two factors resulted in overcrowding within the carpal tunnel. Post-operatively the patient recovered well with pain relief and gradual improvement of his numbness. Variations in the anatomy of the lumbrical muscles is not uncommon and may result in carpal tunnel syndrome. Hence, carpal tunnel release surgeries may not be as straight forward as expected and surgeons should be aware of this possibility.

Fulltext A black finger does not equal a dead finger

Shalimar, A., William, H., Levin, K.B., Parminder G.S., Nur Azuatul, A.K., Tan, J.A.

Medicine & Health, 2018;13(2):229-234.

MyJurnal

Revascularisation and replant surgery occasionally produces sub-optimal results. We present two cases of near total amputation of the digits. The first patient was an 11-year-old boy with a middle finger avulsion injury sustained after the finger was caught in a washing machine with the flexor digitorum profundus still attached. The second patient was a 42-year-old male who sustained a machete attack and had near total amputation of his small and ring fingers with a 2 cm skin bridge still attached. All patients underwent revascularization with repair of only one digital artery for each finger as the opposite artery was non-viable. No digital veins were repaired. Relief of venous congestion was done by pin-prick six times a day up till one week. At one week post-surgery, the fingers were discoloured black but had good pulp turgor and full contour with arterial bleed on pin-prick. Inexperienced surgeons may view this as gangrene and amputate the fingers. However, we continued observation and at one month post-surgery, the black skin had desloughed and the underlying skin was pink.

Fulltext Addressing triggering post zancolli lasso procedure

Mohd Zaim, M.R., Shalimar, A., Parminder Singh Gill N.S., Nur Azuatul, A.K.

Medicine & Health, 2018;13(2):235-240.

MyJurnal

A claw hand causes disability as kinematics are affected due to hyperextension at the metacarpophalangeal joints. Zancolli lasso procedure is a simple tenodesis procedure which effectively lessens clawing to allow better grip. We present a 56-year-old lady who had a history of trauma with progressive clawing of her left hand. She has been diagnosed with partially recovered incomplete lower trunk brachial plexus injury. She underwent successful Zancolli lasso procedures for all of her fingers but 8 months later, the patient developed triggering of the index and middle fingers. We experimented by releasing the adhesions in one finger and releasing the whole A1 pulley together with the lasso-ed flexor digitorum superficialis (FDS) in the other finger and the latter worked.We repeated the procedure in the index finger and the triggering resolved. Although both her index and middle fingers now have a flexor digitorum profundus (FDP) only (the FDS having retracted proximally), she did not have a recurrence of her clawing. We attributed the triggering due to increasing A1 pulley volume as well as contractures causing post-release functional positions.

Fulltext A 2-Year Demographic Study of Domestic Paediatric Hand Injuries Requiring Surgical Intervention in An Urban Hospital

Shalimar, A., Jamari, S., Abdul Halim, A.R., Roohi, S.A., Naicker, A.S., Sharaf, I.

Malays Orthop J, 2007;1(1):34-38.

MyJurnal

Domestic paediatric hand injuries make up the bulk of overall paediatric hand injuries. This is a retrospective study of domestic paediatric hand injuries admitted into an urban hospital that required surgical intervention. The most common injuries sustained were tendon injuries (24%), total amputations (20%) and lacerations wounds (16%). Accordingly the most common surgical interventions were tendon repairs (28%), toilet suturing (24%) and refashioning (20%). Parents and care providers need to be more vigilant and careful when supervising children including ensuring the safe storage of dangerous items. Sharp items may require additional safety features and warning labels.

Fulltext A Study on the Absence of Palmaris Longus in a Multiracial Population

Roohi, S.A., Choon-Sian, L, Shalimar, A., Tan,G.H., Naicker, A.S.

Malays Orthop J, 2007;1(1):26-28.

MyJurnal

Palmaris longus is a dispensable muscle with a long tendon which is very useful in reconstructive surgery. It is absent 2.8 to 24% of the population depending on the race/ethnicity studied. Four hundred and fifty healthy subjects (equally distributed among Malaysia's 3 major ethnic groups) were clinically examined for the presence or absence of palmaris longus. This tendon was found to be absent unilaterally in 6.4% of study subjects, and bilaterally in 2.9% of study participants. Malays have a high prevalence of palmaris longus absence at 11.3% followed closely by Indians at 10.7% whilst Chinese had a low absence rate of 6.0%.

An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy

Haflah NH, Ibrahim S, Sapuan J, Abdullah S

J Pediatr Orthop B, 2010 Sep;19(5):459-61.

PMID: 20555271 DOI: 10.1097/BPB.0b013e32833b6032

Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

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