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Abstract: Dupuytren''s contracture is a retractile fibrosis of the superficial palmar aponeurosis of the hand, resulting in a progressive and fixed flexion of the fingers that may result in severe limitation of hand function. It affects several millions of people in Europe and North America. Risk factors are genetic and sometimes related to mellitus diabetes. There is no spontaneous remission. Until recently, surgery was the only treatment, but now needle aponeurotomy emerges as a therapeutic alternative. It should be performed as first line treatment by a trained practitioner. Short and long-term results of needle aponeurotomy appear identical to those of surgery, with milder complications. It is indicated in palmar, palmo-digital, as well as in strictly digital forms of the disorder. The “table-test” is used to assess the loss of extension of the digit and to select the indication to needle aponeurotomy. A medico-surgical consensus should define the optimum treatment strategy in this affection. [Copyright &y& Elsevier]

Giant-cell tumors of the tendon sheath correspond to a localized form of pigmented villonodular synovitis. GCTTS typically occur in the hand where they represent the second most common type of soft tissue tumors after synovial ganglions. The etiology of giant cell tumors of the tendon sheath is unknown. Pathogenetic theories have included inflammatory process, trauma, immune mechanisms, neoplasia. Giant cell tumors usually present as a solitary and firm slow-growing nodular lesion, which affects the volar aspect of the hand. Multifocal lesions are rarely described in the literature and commonly involve the same finger or the volar aspect of different fingers. We report a rare case of three separate GCT occurring on both aspects of the hand thus raising the question of their etiology. [ABSTRACT FROM AUTHOR]

Abstract: The pain of the ulnar nerve at the elbow is a common problem. The potentially compressive sites are numerous and should be known to avoid therapeutic failure. Pathophysiology is yet better understood but is still debated. Clinical and radiological examination and the EMG allow a better aetiologic definition.The aetiology of the ulnar nerve suffering (entrapment or instability of the nerve), the medical history of the patient, the length and the severity of the complaint explain the great variability in the results observed and the large choice of possible therapies. Apart from the medical treatment, we list the different surgical techniques: in situ neurolysis, medial epicondylectomy, partial medial epicondylectomy, anterior submuscular or intramuscular or subcutaneous transposition. These interventions have near-identical results, leading us to choose for its simplicity in realisation and after surgery, the in situ neurolysis when the nerve is stable. In case of subluxation of the ulnar nerve, we advise partial medial epicondylectomy, which conserves the vascularisation of the nerve, and limits it’s stretching and compression. Partial medial epicondylectomy has, as the total epicondylectomy, good results without the disadvantages. In the case of real instability and in certain cases of severe paralysis, the anterior transpositions, which are more difficult to do and have more complex postoperative care, remain justified. [Copyright &y& Elsevier]

Abstract: The authors report the case of an anatomical variation with a double extensor pollicis longus tendon found during a dorsal approach to the wrist for rheumatoid arthritis. The accessory tendon was located in an additional separate wrist dorsal compartment, which is an extremely rare arrangement. [Copyright &y& Elsevier]

Introduction/Background Treatments of Dupuytren's disease are currently not aetiological but symptomatic. They aim at reducing the flexion contracture of fingers and improving hand function, without excluding the possibility of recurrence. Percutaneous needle aponeurotomy (PNA) can be used as an iterative treatment for repeated recurrences. However, it has only been assessed as a unique therapeutic sequence and its long-term functional results have not been described. The aim of the study was to assess functional results of iterative PNA for Dupuytren's disease at 5-year follow-up. Material and method Patients with digital flexion contracture due to Dupuytren's disease were prospectively included and treated using PNA. Iterative treatment was performed as necessary during the follow-up. Assessment criteria were Tubiana score at 1 month, URAM functional score at 1-month and 5 years, satisfaction and need of second line open surgery at 5 years. Primary outcome was URAM functional score at 5 years in patients who did not undergo second line open surgery at follow-up. Results Thirty patients were included: age 72 ± 10, ratio Female/Male 0.2, diabetes 3, Tubiana score 7 ± 3, URAM score 13 ± 10. Three sessions of PNA were performed per patient in mean at 5-year follow-up. Two adverse events were observed: skin fissure recovering in one week (1 case), digital paresthesia recovering in 2 years (1 case). PNA reduced flexion contracture (Tubiana 2 ± 3, range 0–13, n = 30, P < 0.05). The URAM score was improved at 1 month (7 ± 9, range 0–35) and at 5 years (10 ± 12, range 0–41, n = 27, P < 0.05). Three patients underwent second line open surgery. Seventy-two percent of patients were satisfied by PNA at 5 years and 83% recommended the treatment. Conclusion Iterative PNA is safe, reduces flexion contracture and improves hand function in patients with Dupuyren's disease. Functional improvement persists at 5 years in 90% of cases. Only 10% require second line open surgery. [ABSTRACT FROM AUTHOR]