Al-Najjim M; Mustafa A; Fenton C; Morapudi S; Waseem M; 2013

Giant solitary synovial osteochondromatosis of the elbow causing ulnar nerve neuropathy: a case report and review of literature.
Citation: Journal of Brachial Plexus & Peripheral Nerve Injury, 2013, vol./is. 8/1(1), 1749-7221;1749-7221 (2013)

Abstract: Giant or solitary osteochondroma is part of a rare disorder known as synovial osteochondromatosis. It forms part of a spectrum of disease characterized by metaplastic changes within the joint synovium that are eventually extruded as loose bodies. It has been suggested that solitary synovial osteochondroma forms as progression of synovial osteochondromatosis through a process of either coalescence of multiple smaller bodies or the growth of a dominant synovial osteochondroma. Previous studies have shown that it occurs as a late phase of the disease. We report a rare case of giant synovial osteochondromatosis at the elbow causing ulnar nerve neuropathy and mechanical symptoms which has not been previously reported in the literature.

CASE REPORT: We report a case of a 56 year old Western European gentleman who presented with ulnar nerve neuropathy and swelling behind the elbow. The patient underwent MR imaging and subsequent biopsy that demonstrated synovial osteochondromatosis. Initially the patient declined surgery and opted for a watch and wait approach. Five years later he returned with worsening symptoms and underwent successful surgical resection of a giant solitary synovial osteochondroma.

CONCLUSION: The unique outcome in our patient despite the long interval between presentation and surgical treatment resulted in early full resolution of symptoms within a short period. It may suggest an improved prognosis as compared to multiple synovial osteochondromatosis in terms of mechanical and neurological outcomes.

Publication Type: Journal Article
Full Text: Available from BioMedCentral in Journal of Brachial Plexus and Peripheral Nerve Injury

Dobson R.; Tweddle E.; Scott M.; Cubukcu; BMJ Case Report; 2012

left atriumThis case report on Large left atrial myxoma with an unusual origin was published in Sept 2012 by BMJ Case Reports.    Congratulations to the authors :

  • Rebecca Dobson – Endocrinology Dept, University of Liverpool
  • Emma Tweddle – Cardiology Dept, MDGH
  • Martha Scott – Cardiology Dept, MDGH
  • Arzu Cubukcu – Cardiology Dept, MDGH

BMJ Case Reports Published 24 September 2012; doi:10.1136/bcr-2012-006782

Haider, S, BMJ Case Reports 2012: Images in paediatrics

BMJ Case Reports 2012; doi:10.1136/bcr.10.2011.4904

Images in paediatrics: subcutaneous fat necrosis causing radial nerve palsy

  1. Shahzad Haider Department of Paediatrics, Macclesfield District General Hospital, Cheadle, UK
  2. Correspondence to Dr Shahzad Haider,
A baby boy was born at term by forceps extraction following uneventful pregnancy. The baby did not require resuscitation at birth. On routine postnatal check, it was noticed that the baby had left-sided wrist drop. An area of palpable subcutaneous nodules with some erythema was identified over the lower part of left arm. It was thought to be subcutaneous fat necrosis which had most likely caused radial nerve palsy. There were no associated signs suggested for brachial plexus injury. There was good flexion at the elbow and normal movements at shoulder. There was no evidence of fracture in the upper limb on x-ray. He received physiotherapy in the form of splinting and passive movements to prevent secondary contractures. After 4 weeks, he started showing some minimal extension of the fingers. The skin over the area of fat necrosis was desquamated. At his 10 week follow-up, his left arm seemed completely recovered. He had full range of movements. There is limited literature available relating radial nerve palsy secondary to subcutaneous fat necrosis. It is thought to be due to intrauterine pressure effect and almost universally there is a good recovery.
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