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Flexor pollicis longus rupture following acupuncture for trigger thumb: a case report

Liew SK, Teh KK

Acupunct Med, 2021 08;39(4):398-399.
PMID: 33256436 DOI: 10.1177/0964528420959085
Fulltext The great mimic again? A case of tuberculosis knee

Teo Sh, Teh K, Azura L, Ng Y

Malays Orthop J, 2011 Nov;5(3):32-4.
PMID: 25279034 MyJurnal DOI: 10.5704/MOJ.1111.005

Tuberculosis (TB), once a disease confined to undeveloped or developing nations is currently in resurgence due to pandemic human immunodeficiency virus infection and immigration from endemic areas. TB is also known as the 'great mimicker'. Extra-pulmonary tuberculosis affecting the knee is rare in all forms of TB (0.1-0.3%). Here, we report a case of isolated highly erosive TB knee in a previously fit Burmese migrant worker. He presented with after a history of fall into a drain. The patient also reported pain and swelling over his left knee for the previous three years. He had been treated for a bacterial infection of the knee in another hospital but defaulted due to financial constraints. Arthrotomy of the knee was performed including washout. Diagnosis of TB of the knee was made based on the synovial fluid and tissue culture. Treatment with antituberculosis drugs was then initiated.
Double Embedded Rings of a Digit Leading to Amputation

Liew SK, Fong TS, Teh KK

J Hand Surg Asian Pac Vol, 2021 Mar;26(1):103-106.
PMID: 33559570 DOI: 10.1142/S2424835521720048

Chronic embedded-ring injury is a rare and uncommon presentation. This is also known as "chronic ring erosion" or "embedded ring syndrome" in the literature. Injury of this type has been associated with psychological impairment causing neglect of such injury. We herein describe a case of double embedded rings on the right ring finger in a 30-year-old healthy construction worker. A primary amputation at the metacarpophalangeal joint was performed in view of the chronicity of his condition and associated neurovascular damage. Early removal of ring is of paramount importance in any ring-associated injuries. However, fear of losing a digit has been the reason of delay in seeking medical treatment, which in turn ended up in dire consequences.
Multinodular/plexiform schwannoma of the ulnar nerve

Lim CY, Low TH, Sivanoli R, Teh KK, Thuraisingham R

ANZ J Surg, 2014 Jan-Feb;84(1-2):93-4.
PMID: 24165375 DOI: 10.1111/ans.12231
Mini open carpal tunnel release using Knifelight: evaluation of the safety and effectiveness of using a single wrist incision (cadaveric study)

Teh KK, Ng ES, Choon DS

J Hand Surg Eur Vol, 2009 Aug;34(4):506-10.
PMID: 19675032 DOI: 10.1177/1753193409100962

This cadaveric study evaluates the margin of safety and technical efficacy of mini open carpal tunnel release performed using Knifelight (Stryker Instruments) through a transverse 1 cm wrist incision. A single investigator released 32 wrists in 17 cadavers. The wrists were then explored to assess the completeness of release and damage to vital structures including the superficial palmar arch, palmar cutaneous branch and recurrent branch of the median nerve. All the releases were complete and no injury to the median nerve and other structures were observed. The mean distance of the recurrent motor branch to the ligamentous divisions was 5.7 +/- 2.4 mm, superficial palmar arch was 8.7 +/- 3.1 mm and palmar cutaneous branch to the ligamentous division was 7.2 +/- 2.4 mm. The mean length of the transverse carpal ligament was 29.3 +/- 3.7 mm. Guyon's canal was preserved in all cases.
Fulltext Stonefish envenomation of hand with impending compartment syndrome

Tay TK, Chan HZ, Ahmad TS, Teh KK, Low TH, Wahab NA

J Occup Med Toxicol, 2016;11:23.
PMID: 27168760 DOI: 10.1186/s12995-016-0112-y

BACKGROUND: Marine stings and envenomation are fairly common in Malaysia. Possible contact to various marine life occurs during diving, fishing and food handling. Even though majority of fish stings are benign, there are several venomous species such as puffer fish, scorpion fish, lionfish, stingray and stonefish that require urgent medical treatment. Stonefish is one of the most venomous fish in the world with potential fatal local and systemic toxicity effects to human.
CASE PRESENTATION: We reported a case of stonefish sting complicated with impending compartment syndrome.
CONCLUSIONS: Medical staff should be alert about the possibility of this potential emergency in standard management of stonefish stings.
Fulltext Radiological analysis of the medial epicondyle in the adolescent throwing athlete

Ng WM, Chan CK, Takahashi N, Kawai N, Teh KK, Saravana R, et al.

Singapore Med J, 2017 Feb;58(2):103-106.
PMID: 26976222 DOI: 10.11622/smedj.2016061

INTRODUCTION: Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODS: In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTS: Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm2, while that of the non-dominant arm was 189.14 ± 39.56 mm2(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSION: Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Study done in Japan
Fulltext Femoral head diameter in the Malaysian population

Lee CK, Kwan MK, Merican AM, Ng WM, Saw LB, Teh KK, et al.

Singapore Med J, 2014 Aug;55(8):436-8.
PMID: 25189306

INTRODUCTION: Hip arthroplasty is commonly performed worldwide. The objective of this study was to determine the diameter of the femoral head in the Malaysian population in relation to gender and race (i.e. among Malay, Chinese and Indian patients).

METHODS: This was a retrospective cross-sectional study performed between January 1995 and December 2006, evaluating the femoral head diameters of all patients aged 50 years and above who underwent hemiarthroplasty at two major hospitals in Malaysia.

RESULTS: A total of 945 femoral heads (663 women, 282 men) were evaluated. The mean age of the patients in our cohort was 75.2 ± 9.4 (range 50-101) years. The mean femoral head diameter (with intact articular cartilage) was 44.9 ± 3.2 (range 38-54) mm. In our study, men had a significantly larger mean femoral head diameter than women (47.7 ± 2.8 mm vs. 43.7 ± 2.4 mm; p < 0.05). Patients of Chinese ethnicity were also found to have significantly larger femoral head diameters, when compared among the three races studied (p < 0.05).

CONCLUSION: Malaysians have a mean femoral head diameter of 44.9 ± 3.2 mm. Among our patients, Chinese patients had a significantly larger femoral head size than Malay and Indian patients. We also found that, in our cohort, men had significantly larger femoral head diameters than women.
Vibration-Controlled Transient Elastography Scores to Predict Liver-Related Events in Steatotic Liver Disease

Lin H, Lee HW, Yip TC, Tsochatzis E, Petta S, Bugianesi E, et al.

JAMA, 2024 Apr 16;331(15):1287-1297.
PMID: 38512249 DOI: 10.1001/jama.2024.1447

IMPORTANCE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most common chronic liver disease worldwide. It is important to develop noninvasive tests to assess the disease severity and prognosis.
OBJECTIVE: To study the prognostic implications of baseline levels and dynamic changes of the vibration-controlled transient elastography (VCTE)-based scores developed for the diagnosis of advanced fibrosis (Agile 3+) and cirrhosis (Agile 4) in patients with MASLD.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included data from a natural history cohort of patients with MASLD who underwent VCTE examination at 16 tertiary referral centers in the US, Europe, and Asia from February 2004 to January 2023, of which the data were collected prospectively at 14 centers. Eligible patients were adults aged at least 18 years with hepatic steatosis diagnosed by histologic methods (steatosis in ≥5% of hepatocytes) or imaging studies (ultrasonography, computed tomography or magnetic resonance imaging, or controlled attenuation parameter ≥248 dB/m by VCTE).
MAIN OUTCOMES AND MEASURES: The primary outcome was liver-related events (LREs), defined as hepatocellular carcinoma or hepatic decompensation (ascites, variceal hemorrhage, hepatic encephalopathy, or hepatorenal syndrome), liver transplant, and liver-related deaths. The Agile scores were compared with histologic and 8 other noninvasive tests.
RESULTS: A total of 16 603 patients underwent VCTE examination at baseline (mean [SD] age, 52.5 [13.7] years; 9600 [57.8%] were male). At a median follow-up of 51.7 (IQR, 25.2-85.2) months, 316 patients (1.9%) developed LREs. Both Agile 3+ and Agile 4 scores classified fewer patients between the low and high cutoffs than most fibrosis scores and achieved the highest discriminatory power in predicting LREs (integrated area under the time-dependent receiver-operating characteristic curve, 0.89). A total of 10 920 patients (65.8%) had repeated VCTE examination at a median interval of 15 (IQR, 11.3-27.7) months and were included in the serial analysis. A total of 81.9% of patients (7208 of 8810) had stable Agile 3+ scores and 92.6% of patients (8163 of 8810) had stable Agile 4 scores (same risk categories at both assessments). The incidence of LREs was 0.6 per 1000 person-years in patients with persistently low Agile 3+ scores and 30.1 per 1000 person-years in patients with persistently high Agile 3+ scores. In patients with high Agile 3+ score at baseline, a decrease in the score by more than 20% was associated with substantial reduction in the risk of LREs. A similar trend was observed for the Agile 4 score, although it missed more LREs in the low-risk group.
CONCLUSIONS AND RELEVANCE: Findings of this study suggest that single or serial Agile scores are highly accurate in predicting LREs in patients with MASLD, making them suitable alternatives to liver biopsy in routine clinical practice and in phase 2b and 3 clinical trials for steatohepatitis.