Primary tumoral calcinosis is a rare and benign condition characterized by calcium salt deposition in periarticular soft tissues. It typically presents as a firm, rubbery mass that arises around large joints. While an estimated 250 cases have been described since its discovery, very few cases have been identified in the hand. We present a case of multiple calcified masses in the hand, one of which required meticulous dissection from a digital neurovascular bundle, and our technique for surgical excision. We present this case to lower the threshold for clinical suspicion of tumoral calcinosis for patients who present with a soft tissue mass in the hand. Furthermore, we recommend prompt surgical excision due to low success rates of alternative treatment options and to prevent potential neurovasculature or tendon injury.

Plexiform schwannoma is an uncommon benign tumour that grows in a plexiform pattern. We report a 47-year-old man with a mass on the palmar aspect of the metacarpophalangeal joint of the right index finger that had been growing gradually for more than 10 years. The mass was palpated from the distal carpal tunnel to the ulnar aspect of the proximal interphalangeal joint of the index finger, with tingling and numbness sensation. The tumour was a multinodular tumour involving the first common palmar digital nerve to the ulnar proper palmar digital nerve. It was resected and reconstructed with a sural nerve graft. Plexiform schwannoma is rare in the digital nerve, with only six cases reported. Generally, classic schwannomas can be enucleated without causing neurologic deficits; however, plexiform schwannoma may require nerve resection. There have been reports of recurrence of plexiform schwannoma; definitive resection and long-term follow-up are necessary. Level of Evidence: Level V (Therapeutic).

Intraneural ganglia are rare, benign cysts that form within the epineurium of the affected nerve. Patients present with features of compressive neuropathy, including numbness. We report a 74-year-old male patient with pain and numbness on his right thumb of 1-year duration. Magnetic resonance imaging revealed a cystic lesion with a possible scaphotrapezium-trapezoid joint connection. The articular branch was not identified during the surgery and decompression with excision of the cyst wall was done. A recurrence of the mass was noted 3 years later, but the patient was asymptomatic and no additional intervention was done. Decompression alone can relieve the symptoms of an intraneural ganglion, but excision of the articular branch may be essential in preventing its recurrence. Level of Evidence: Level V (Therapeutic).

We present a patient with Pacinian corpuscle hypertrophy and hyperplasia in the hand and discuss the diagnosis and treatment of this rare condition. A 46-year-old woman presented with radiating pain of the left middle finger. A strong Tinel-like sign was elicited between the index and middle fingers. The patient frequently used mobile phone, with the corner of the phone consistently applying pressure on the palm. The surgery was carried out under the microscope and two enlarged cystic lesions under the epineurium were found in the proper digital nerve. Histologic examination revealed hypertrophied Pacinian corpuscle with normal structure. Postoperatively, her symptoms gradually improved. Preoperative diagnosis of this disease is very difficult. Hand surgeons should keep this disease in mind preoperatively. In our case, we would not have been able to identify multiple hypertrophic Pacinian corpuscles without the microscope. An operating microscope is recommended in a surgery of this nature. Level of Evidence: Level V (Therapeutic).

Introduction: Limited fasciectomy is the gold-standard treatment in Dupuytren’s surgery. The anatomical position of digital nerves can be altered by Dupuytren’s tissue resulting in a difficult dissection and localization, with a relatively high risk of iatrogenic nerve injury. This risk could be decreased by using intraoperative neural marking to facilitate locating the potentially displaced nerves. We recently demonstrated in an animal model that in vivo nerve staining with methylene blue is a suitable method to mark nerves without damaging them. Objective: We aimed to test the efficacy of our methylene blue nerve staining technique developed in a rat sciatic nerve model on human cadaveric digital nerves. Method: First, we performed epineural staining using 40 μl 1 : 80 diluted methylene blue solution on four human cadaver digital nerves fixed with formalin. In the second experiment, we stained six cadaver digital nerves without previous fixation. To increase the length of the stained segments, we used 200 μl solution on two nerves. Results: The epineural nerve labeling was not successful on formalin-fixed tissues. However, nerves without fixation were successfully stained with methylene blue. Forty μl methylene blue solution marked a 13 mm long segment, while 200 μl stained a 18 mm long segment. Conclusion: The epineural methylene blue nerve staining is limited on formalin-fixed digital nerves due tissue shrink-age. Non-fixed nerves with preserved histological structure can be stained in an 18 mm long segment. Further studies are necessary to determine the technique’s value in hand surgery by testing digital nerves surrounded by Dupuytren’s and scar tissues.
Bevezetés: A parciális aponeurectomia a Dupuytren-kontraktúra kezelésére leggyakrabban végzett műtéti eljárás. A betegségben kialakuló patológiás szövet megváltoztathatja a digitális ideg anatómiai elhelyezkedését, ami megnehezíti az ideg műtét közbeni lokalizációját és dissectióját, és növeli a iatrogén idegsérülés kockázatát. Intraoperatív idegfestési eljárással az ideg lokalizációja megkönnyíthető lenne, ezáltal a iatrogén idegsérülés kockázata is csökkenne. Állatkísérleteinkben korábban igazoltuk, hogy metilénkékoldattal a perifériás ideg in vivo megfesthető az ideg struktúrájának és funkciójának károsítása nélkül. Célkitűzés: A patkány nervus ischiadicus modellen már sikeresen alkalmazott metilénkékoldattal végzett idegfestési eljárás hatékonyságának vizsgálata humán kadáver digitális idegen. Módszer: Vizsgálatunk első fázisában formalinnal fixált kézen négy digitális ideg epineuralis festését végeztük el 40 µl 1 : 80-as hígítású metilénkékoldattal. A második vizsgálatban fixáción át nem esett kadáverkézen hat digitális ideg festését végeztük. A megfesthető idegszakasz hosszának növelésére két ideg festéséhez 200 µl metilénkékoldatot használtunk. Eredmények: Az epineuralis idegjelölés formalinfixált idegeken nem működött ideálisan. Friss, formalinos fixáláson át nem esett humán kadáver digitális idegen az idegfestési eljárást sikeresen alkalmaztuk, a megfestett idegszakasz tekintetében állatkísérletes eredményeinket reprodukálni tudtuk. 40 µl 1 : 80-as hígítású metilénkékoldattal átlagosan 13 mm-es, míg 200 µl oldat használatával 18 mm-es idegszakaszt sikerült megfesteni. Következtetés: Formalinnal fixált digitális ideg festése a fixáció következtében fellépő szöveti zsugorodás miatt korlátozottan lehetséges. Formalinos fixáláson át nem esett digitális idegek esetén a megtartott anatómiai viszonyok mellett 18 mm-es idegszakasz megfesthető. További vizsgálatokat tervezünk Dupuytren-szövettel és hegszövettel körülvett digitális idegen, a technika kézsebészeti műtétek során történő alkalmazhatóságának megítélésére. Orv Hetil. 2022; 163(46): 1834–1839

BACKGROUND: The primary aim of this study was to present patient-reported functional outcomes after zone 1 and 2 flexor tendon repair using a novel longitudinal volar approach crossing the distal interphalangeal joint (DIPJ) perpendicularly. The secondary aims were to investigate the cosmetic outcomes, satisfaction and complication rates associated with this technique.
METHODS: Over a 6-year period, 75 patients underwent flexor tendon repair using this technique. The quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), five-level EQ-5D (EQ-5D-5L), Patient and Observer Scar Assessment Scale (POSAS) and satisfaction questionnaires were collected. QuickDASH scores were available for 59 patients (79%), and POSAS scores were available for 45 patients (60%) at a mean follow-up of 48 months. Concomitant nerve repairs were undertaken in 24 cases.
RESULTS: The median QuickDASH score was 4.5 (interquartile range [IQR] 1.1-12.5) and median POSAS score was 12 (IQR 8-16). No significant difference was observed in median QuickDASH score between patients with and without a concomitant nerve repair (4.5 vs 6.8; p = 0.36). Fifty-six patients (94%) were satisfied. Two patients required open tenolysis, and a single case of early re-rupture occurred that required revision open repair.
CONCLUSIONS: Utilising validated patient-reported functional outcomes, this study demonstrated that a direct longitudinal incision over the DIPJ for zone 1 and 2 flexor tendon repairs can result in excellent functional and cosmetic outcomes, with high rates of patient satisfaction and low rates of complications. This challenges previously held dogma that longitudinal incisions crossing flexion creases should be avoided.

BACKGROUND: Post-traumatic neuropathic pain is a major factor affecting the quality of life after finger trauma and is reported with considerable variance in the literature. This can partially be attributed to the different methods of determining neuropathic pain. The Douleur Neuropathique 4 (DN4) has been validated to be a reliable and non-invasive tool to assess the presence of neuropathic pain. This study investigated the prevalence of neuropathic pain after finger amputation or digital nerve repair using the DN4 questionnaire.
METHODS: Patients with finger amputation or digital nerve repair were identified between 2011 and 2018 at our institution. After a minimal follow-up of 12 months, the short form DN4 (S-DN4) was used to assess neuropathic pain.
RESULTS: A total of 120 patients were included: 50 patients with 91 digital amputations and 70 patients with 87 fingers with digital nerve repair. In the amputation group, 32% of the patients had pain, and 18% had neuropathic pain. In the digital nerve repair group, 38% of the patients had pain, and 14% had neuropathic pain. Secondly, of patient-, trauma-, and treatment-specific factors, only the time between trauma and surgery had a significant negative influence on the prevalence of neuropathic pain in patients with digital nerve repair.
CONCLUSIONS: This study shows that persistent pain and neuropathic pain are common after finger trauma with nerve damage. One of the significant prognostic factors in developing neuropathic pain is treatment delay between trauma and time of digital nerve repair, which is of major clinical relevance for surgical planning of these injuries.

UNASSIGNED: Digital nerve lacerations are rationally common, especially following penetrating injuries. The majority of patients suffer from numbness as the main complaint. However, electric shock pain is a rare manifestation of partial nerve injury.
METHODS: A 65-year-old woman with partial digital nerve injury and an electric shock sign due to a 1 cm laceration on the volar side of the proximal phalanx three weeks earlier. The surgical exploration revealed a neuroma-like mass in the digital nerve; however, the continuity of the nerve was grossly intact.
UNASSIGNED: Due to the superficiality of digital nerves, penetrating nerve injuries are rationally common in this area. Laceration of the digital nerve could lead to loss of sensation, clumsiness, and even loss of function. Gradually, neuroma formation would add a local pain and electric shock sign to the mentioned symptoms.
CONCLUSIONS: Electric shock sign is characteristic for partial digital nerve injury with unknown mechanism. It seems the symptoms would be progressive and more complicated with neuroma formation.
METHODS: V.

To measure the neuromagnetic fields of carpal tunnel syndrome patients after electrical digital nerve stimulation and evaluate median nerve function with high spatial resolution.
A superconducting quantum interference device magnetometer system was used to record neuromagnetic fields at the carpal tunnel after electrical stimulation of the middle digital nerve in 10 hands of nine patients with carpal tunnel syndrome. The patients were diagnosed based on symptoms (numbness, tingling, and pain) supported by a positive Phalen or Tinel sign. A novel technique was applied to remove stimulus-induced artifacts, and current distributions were calculated using a spatial filter algorithm and superimposed on X-ray.
In 6 of the 10 hands, the amplitude of the inward current waveform attenuated to <70% or the nerve conduction velocity was <40 m/s. The results of conventional nerve conduction studies were normal for two of these six hands. All four hands that could not be diagnosed by magnetoneurography had severe carpal tunnel syndrome superimposed on peripheral neuropathy secondary to comorbidities.
Technical improvements enabled magnetoneurography to noninvasively visualize the electrophysiological nerve activity in carpal tunnel syndrome patients.
Magnetoneurography may have the potential to contribute to the detailed diagnosis of various peripheral nerve disorders.

Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation.
All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores.
A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P < .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas (P < .01).
Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker\'s compensations status were significantly associated with symptomatic neuroma formation.