Pain, Arthritis

*Glomus Tumour + Neurofibroma

The patient was diagnosed with a condition called Neurofibroma. In addition, there was severe pain under several nails. These were Glomus Tumours. These small size benign tumour were removed for pain relief.

Before & After Surgery

*Painful Wrist: Kienbock's Disease.

Symptoms: The patient presents with pain on the dorsal aspect of the wrist and restricted movement of the affected wrist. There may sometime be history of some minor injury in the past. It is a progressive disease and hence appropriate treatment must be sought early.

Investigation: In early stages of pain, the x rays are normal but the MRI may pick up signals of disease. As the disease progresses, the x ray picture changes and adjacent bones are also affected.

Treatment: There are various surgical options available.

  • Shortening of the radius is one option followed by plating of the radius. This procedure reduces the load on the lunate bone. The results are predictable and alleviates the pain. Yet there are other options of treatment.
  • Capitate shortening. If the adjacent ulna is too long, the patient may be a candidate for capitate shortening.
  • Decompression of radius.
  • Inter carpal fusion.
  • Proximal row carpectomy.

Capitate shortening and Kirschner wire fixation.

Before Surgery

After Surgery

The arrow points at the diseased lunate bone. The pain was eliminated by shortening the radius bone and preconditioned plate was applied.

Before Surgery

After Surgery

*Painful Elbow, Forearm.

  • Pain in Elbow and Forearm may be radial tunnel syndrome.
  • Pain in the upper forearm. This is a common condition characterized by pain in the upper part of the forearm on the outer side (Radial). In other words, it is located just distal to the outer aspect of the elbow joint.
  • The pain is located over the muscle and not the bone. If the pain is over the bone, it is likely to be the Tennis elbow. The condition is often mixed up and called tennis elbow. Both are different and have different treatments.
  • The pain occurs because the nerve is pinched under a muscle (Supinator). At times, the pain radiates down the forearm. On other occasions, the pain may be referred to as the shoulder.

*During Surgery

*Tennis Elbow.

The patient complains of pain on the outer aspect of the elbow over the prominence of the bone(Lateral epicondyle), the pain is quite disabling. The pain occurs because certain muscle fibers get prematurely degenerated, there is no way these muscle fibers will get rejuvenated.

Beside medicines, the patient will get relief from eccentric loading exercises. Counter force braces.

Local injection of steroid may be tried, but extremely important to not repeat the inject more than once. Even a single injection should be avoided and given in rare situations.

Persistence of symptoms is an indication for surgery. The degenerated muscle fibers are removed during surgery using a small incision over the elbow region.

*Pain Glomus Tumour.

The pain is under the nail. It is very painful. Quite often in the absence of appropriate diagnosis, the pain persists for several years and decades.
Classically, the pain is under the nail and can be pinpointed with the tip of your pen. In sunlight you my notice a well localized focal blue spot under the nail or in one of the corners of the nail.

This may be confirmed on a good quality 3 Tesla MRI. The only treatment is surgical removal. At times it may recur. It is to be sent for histo pathology examination for further study.

*Painful Wrist: Carpal Boss.

The patient present with a localized bump on the dorsum of the wrist. This is bony hard and located over the base of the 2 or 3 metacarpals. it may be confused with a ganglion.

This is due to premature degeneration of the 2 and/or third carpometacarpal joint. A special x-ray is taken. The wrist is acutely flexed and a tangential lateral view will show the new bone in profile.

Failure of non-operative treatment will require surgery .The new bone is shaved off from under the wrist extensor tendons.

Before and After Surgery

*Arthritis, Pain.

Pain at the base of the thumb is a common disability. In medical parlance, it is called Basal Joint Arthritis or First Carpo metacarpals Joint Arthritis or First CMC Joint Arthritis. It is said that almost 3 out of 10 females at some point of time will get pain in their thumb which may be very disabling. While some patients may require activity modification to get rid of pain, others may require an external support. However, the last resort is surgery. There are various types of procedures available. One of the procedure involves removal of the arthritic bone (Trapezium).This procedure offers lasting relief from the pain.

Before Treatment

Arrow pointing at arthritic new bone.

After Treatment

The arthritic bone has been removed.