Background:Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis.Materials and Methods:We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months.Results:There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup.Conclusion:The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.

Introduction: RCVS is a cerebrovascular disorder characterized by multisegmental narrowing of the cerebral arteries with a spontaneous resolution in 1-3 months. It most commonly presents as a sudden onset of a "thunderclap" headache which may be associated with mild neurological symptoms. It may be complicated by subarachnoid haemorrhage, intracerebral haemorrhage, stroke or seizures. Diagnosis is confirmed by "string of beads appearance" of the intracerebral arteries on a cerebral angiography. Case presentation: We present a case of a 65-year-old female, who presented with sudden onset of intense headache and associated with visual disturbances (homonymous hemianopia) with CT evidence of subarachnoid haemorrhage in the superficial cortical sulci. Catheter angiography showed string of beads pattern with focal areas of vasoconstriction and dilatation. Provisional diagnosis of RCVS was made and the patient was treated with calcium channel blockers. Patient demonstrated complete resolution of symptoms and got discharged. Conclusion: RCVS is being increasingly recognised as one of the causes of thunderclap headaches and demonstrates characteristic abnormalities on angiography which are reversible over time. High degree of suspicion and timely diagnosis can potentially reduce the morbidity.

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