A 7-year-old boy presented with both of his thumbs flexed (Figure 1), the inability to perform the
‘thumbs-up’ gesture, and difficulties in opposing thumbs and fingers in activities such as holding a
pencil during writing, pincer movements, and picking up small objects. His mother only observed
the deformity for one month after the boy complained of difficulty in writing during class. He
had no prior history of trauma to the thumbs or pain and swelling in other joints. There were no
other birth anomalies noticed by his parents. Upon examination, the boy had flexion deformities
of the interphalangeal joint (IPJ) on both of the thumbs. Passive range of motion of the IPJ was
not possible and both were fixed at 60° of flexion. Power of both thumbs could not be assessed as
there was no motion of the joint. The range of motion of the metacarpophalengeal joints (MCPJ)
of both thumbs and all other finger joints was normal. A 0.5cm x 0.5cm subcutaneous nodule was
palpable at the volar crease of the MCPJ bilaterally. The nodule was tender on palpation; however,
no overlying skin changes were evident. (Copied from article).
Extraintestinal Salmonella infection involving the thoracic spine is very rare. It commonly presents with non-specific chronic back pain and can occur with no gastrointestinal manifestation. Blood test results and imaging findings are often indistinguishable from more common chronic spine infections such as spine tuberculosis. Culture studies remain the key to establishing a definitive diagnosis and subsequently successful treatment. We report a case in which a patient presented with symptoms and signs suggestive of spine tuberculosis, yet the culture examination revealed otherwise.
INTRODUCTION: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions-if undetected early-may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities.
METHODS: A clinical review of a patient with chronic left heel pain was performed. Blood parameters and imaging investigations indicated chronic infection of the calcaneum. Histopathological examination was highly suggestive of tuberculosis.
RESULT: The patient responded well to antituberculous therapy. She was pain free and showed no signs of recurrence at final follow-up.
CONCLUSION: Here, we report a case of chronic heel pain, which was later diagnosed as tuberculosis of the calcaneum and successfully treated with antituberculous therapy.
Locked knee is an orthopaedic condition requiring urgent treatment. Although the condition can be diagnosed via history, physical examination and imaging studies, the cause of the mechanical obstruction may only be apparent during arthroscopic examination of the knee joint. It is known that imaging plays a role in evaluating the integrity of intra-articular structures, however in some atypical cases, imaging cannot identify the definitive cause of locked knee. Here we report on two cases of locked knee, due to uncommon conditions which were unobservable via normal imaging studies.
Heterotopic ossification in soft tissue or muscle is rare in the pediatric and adolescent age group. Most cases are associated with musculoskeletal injury and trauma to the central nervous system. Here, we describe an adolescent patient without a history of trauma or lesions in the central nervous system who presented with a painful limp with limited motion of the left hip. Investigations indicated unusually large heterotopic ossification extending from the inner aspect of the ilium down to the anterior part of the hip, highly likely to have developed after an unrecognized periacetabular pyomyositis primarily involving the iliacus muscle. Surgical excision was performed successfully without perioperative complications. No recurrence was detected at the final follow-up.
Nursemaid's elbow is a radial head subluxation caused by axial traction on the extended arm while the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that the child was moving the right upper limb less often and there was tenderness over the right elbow. X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of conservative management was decided upon and the patient was placed on a right elbow backslab with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or neurological deficit noted. A repeate x-ray revealed normal findings.