Introduction: Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ul- trasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm ie larger, while non-CTS patients had a mean of 0.797 cm inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were sta- tistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.
De Quervain's tenosynovitis is a common cause of radial sided wrist pain and is described as an entrapment tendinitis of the tendons in the first extensor compartment. Physiotherapy and splinting are initial conservative treatment. Steroid injections are an effective treatment modality but may fail due to the anatomical variation in the first dorsal compartment of the wrist. We present a 39-year-old female who failed conservative treatment. She received a steroid injection, but symptoms resolved for 6 months only. We proceeded to surgery and noted three subcompartments consisting of one for the extensor pollicis brevis and two for the abductor pollicis longusas opposed to one extensor compartment. The steroid injection may have failed to infiltrate all the subcompartments resulting in treatment failure. General practitioners and surgeons must be aware of this variation if there are to provide effective treatment. Ultrasonographic guidance may be required for steroid injections in recalcitrant de Quervain's disease.
Patients with myelomeningocele associated with severe kyphoscoliosis usually presented with rigid and angulated gibbus at their back. The condition causes this group of patients to face difficulties in their daily activities, especially in sitting and lying in supine positions. They are also prone to have a pressure sore over the gibbus and encounter the risk of infection. Here the authors would present a case of a four-year-old girl with underlying myelomeningocele who was diagnosed with worsening kyphoscoliosis along her growth. Her whole spine x-ray radiograph revealed a kyphosis angle of 80° between the T11 and L4 levels. The patient underwent a deformity corrective surgery with total kyphectomy in a combination of anterior and posterior spinal instrumentation. In the present case, we were able to obtain sufficient correction of the spinal kyphotic deformity in that patient in a single-stage surgery with satisfactory surgical outcomes at a four years follow-up.
Introduction Managing patients who present with symptoms of cervical myelopathy secondary to cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. Various factors such as the number of levels involved with OPLL, types of OPLL, canal occupying ratio, K-line characteristics, and C2-C7 lordosis angle were found to guide decision-making and surgical approaches in managing this condition. However, no clear treatment algorithm has been published. This study aims to investigate the outcome of the management of cervical OPLL using a treatment algorithm used in a tertiary university hospital. Methods This is a retrospective cross-sectional study. Patients with cervical myelopathy secondary to cervical OPLL who were treated surgically in our center from 2014 to 2020 were included in this study. Demographic data and preoperative parameters that determined the treatment given according to our treatment algorithm were analyzed. Result A total of 24 patients fit the inclusion and exclusion criteria of the study. The mean recovery rate for all groups is 61.8[Formula: see text]21.9% and the mean postoperative neck disability index (NDI) is 17.83[Formula: see text]16.67%. There was a statistically significant difference between preoperative and postoperative Japanese Orthopaedic Association (JOA) scores for both anterior and posterior surgery subgroups. Conclusion We believe that the treatment algorithm used in our center could benefit other surgeons as a guide in managing patients who suffer from cervical myelopathy secondary to cervical OPLL. Further study including newer techniques would increase the surgeon's arsenal in providing the best outcome in managing this condition.
Giant cell tumour (GCT) is a benign bone tumour characterised by osteoclastic-like multinucleated cells. This tumour predominantly occurs in adults during the third decade of life, commonly in the distal femur, proximal tibia, distal radius, and sacrum. Treatment options include wide local excision with possible adjuvant therapy depending on tumour size and site. We present a case of an 18-year-old lady with no prior medical history complaining of worsening insidious onset localised back pain and preceding numbness of the bilateral lower limbs, diagnosed with a giant cell tumour of the spine (T11).