Study design: Diagnostic test study.Background: There is a growing body of evidence of different physiotherapy tools used to diagnose De Quervain Tenosynovitis. However, the tool that is most useful still needs to be elucidated. Purpose:The purpose of this clinical study was to evaluate the validity and reliability of the Finkelstein test.Methods: This study included 45 healthy individuals. The Finkelstein test, Wrist Hyperflexion and Abduction of the Thumb test (WHAT) and the Eichhoff test were performed by two clinical physiotherapists. Any pain reported was measured using a VAS scale (0 10). Inter-rater reliability and Test-retest reliability was studied with a second measurement one week later. Results:The Finkelstein´s and Eichhoff´s tests revealed False Positives, of 46,7% and 53,3% respectively. The percentage of agreement for the WHAT test was fair (0.21 0.40) and for the Eichhoff test, moderate (0.41 0.60). Reliability of Finkelstein's test with regard to the presence or absence of pain revealed a moderate agreement (Kappa=0.41 0.60). Inter rater reliability had a moderate percentage of agreement (Kappa=0.41 0.60) assessing the presence of pain or no pain; and a fair percentage of agreement (Kappa result=0.21 0.40) when pain was measured with VAS with results being statistically significant (p<0,05). Conclusions:Finkelstein´s test alone, does not appear to validly and reliably assist in the assessment and diagnosis of De Quervain's tenosynovitis.

We report a rare case of adrenal extramedullary haematopoiesis (EMH) in a thalassaemia patient in Cyprus. A 40-year-old woman with β-thalassaemia presented with a 2-day history of non-specific right-sided abdominal pain on routine follow-up for her thalassaemia treatment. Her laboratory tests were not dissimilar to her routine results and no palpable mass was detected. Computed tomography findings revealed a 5.8×4.2×4.6cm solid lesion in the right adrenal gland. Surgical excision was advised for this symptomatic large tumour with the possibility of malignancy in a young patient, and a laparoscopic adrenalectomy was performed. Postoperative follow-up was uneventful. A review of the literature in PubMed and MEDLINE revealed 14 case reports worldwide with adrenal EMH secondary to β-thalassaemia. EMH tumours in patients with thalassaemia have been reported incidentally, which stresses the importance of considering this in the list of differentials of adrenal incidentalomas in this patient population.

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A man in his mid-40s presented to hospital with confusion, headache and feeling generally unwell. He had had a total resection of a grade IV astrocytic glioma 1 year prior. Initial observations, blood tests and CT head scan were unremarkable for acute features to explain the patient’s presentation. However, an MRI head scan on this admission demonstrated a clear communicating hydrocephalus with new abnormal leptomeningeal enhancement, consistent with leptomeningeal metastatic infiltration by glioma. Lumbar puncture cytology and biochemistry supported this interpretation. As a small district general hospital in rural Wales, we discuss the experience of diagnosis and coordination of specialist input from a multidisciplinary team. We share the challenges of managing leptomeningeal disease in the COVID-19 pandemic, in the context of the additional risks this presents with chemotherapy-induced immunosuppression.

Aim The aim of this study is to evaluate the effect of minimally invasive surgery over open surgery for hallux valgus with respect to surgical outcomes and patient reported outcomes. Method Medline Complete, PubMed, Cochrane Library, Scopus, SAGE Journals and gray literature were searched. Primary outcomes focused on hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle. Secondary Outcomes included the American Foot & Ankle Society Score (AOFAS), as well as Pain on a Visual Analogue Scale(VAS), patient satisfaction, complications, SF-36 questionnaire and Manchester Oxford Foot Questionnaire (MOXFQ). Results & Conclusions 8 randomized trials and 7 cohort studies were identified (n=907). Radiological outcomes between similar techniques were found to have no significant difference pre-post operatively at final follow up. Visual analogue scale scores were found to be significantly lower in the MIS groups compared to open techniques (MICA v Scarf) in the short term at Day 1 (P&lt;0.00001) MD= -1.96 95% CI: -2.28, -1.65; I2 = 0%; Week 2 (P=0.001) MD= -1.40; 95% CI: -2.26, -0.54; and Week 6 (P=0.005) MD= -1.50; 95% CI: -2.55, -0.45. There was no statistical difference at 6 months (P=0.46) MD= -0.16; 95% CI: -0.59, 0.27; I2 = 0%; or final follow up (6 m to &gt;24m) (P=0.94) MD= -0.02; 95% CI: -0.44, 0.41; I2 = 0%.). There were no statistically important differences between post-operative AOFAS scores across comparisons, whereas AOFAS mean difference was found to be significantly higher in Open Scarf vs MICA (P = 0.003); MD=-5.54; 95% CI: -9.19, -1.88. I2 = 0%.