One hundred and twenty-seven trigger thumbs in 115 adult patients were randomised to either percutaneous release with steroid injection (n=66) or steroid injection alone (n=61). Two patients, one from each group, were lost to follow-up. Percutaneous release with steroid injection produced satisfactory results in 91% of cases whereas steroid injection alone produced satisfactory results in 47% of cases. One case in the percutaneous group developed stiffness and one in the injection group developed cellulitis. No digital nerve injury occurred in either group. We conclude that percutaneous trigger thumb release combined with steroid injection has a higher success rate than that of steroid injection alone.

Focal periphyseal edema (FOPE) is a recently described condition seen on Magnetic Resonance Imaging (MRI) scans of adolescent patients in relation to knee pain. Since its description in 2011, and proposal as a possible reason for adolescent knee pain, few case series have been published. We report a case of an adolescent male with activity-related knee pain and FOPE finding on MRI scan of his knee. On reviewing medical literature we found nine case series reported with regards to FOPE zone. We have reviewed the demographic and clinical characteristics of the reported cases. With this report we aim to bring more awareness about this condition amongst orthopaedic surgeons.

We present our initial experience of orthopaedic surgeon operated ultrasound examination as an extension of physical examination of the shoulder in our outpatient setting. MATERIALS AND METHODS: We retrieved information of all cases that underwent shoulder ultrasound examination in our outpatient clinic from June 2019 to Mar 2020. We reviewed the demography of the patients, their presenting symptoms and shoulder ultrasonographic findings. We also reviewed medical literature pertaining to accuracy of ultrasound detection of rotator cuff pathology, short learning curve for orthopaedic surgeons who are interested in acquiring proficiency in the use of ultrasound for shoulder examination, and increased accuracy of ultrasound guided therapeutic injections. RESULTS: We identified 90 patients who underwent outpatient clinic-based shoulder ultrasound examination. There were almost equally divided between males and females. Average age was 57 years. Pain was the most common chief complaint. We identified 12 different ultrasonographic pathologies in isolation or in combination. We describe the ultrasound findings in these pathologies. Most common ultrasonographic pathologies were subacromial-subdeltoid (SASD) bursitis and supraspinatus tendinitis or combination of both. Fifty-four ultrasound-guided therapeutic injections were performed. In our literature review we found overwhelming evidence for high accuracy for detection of rotator cuff pathology by orthopaedic surgeons, comparable to radiologists. There is also evidence of a shorter learning curve for orthopaedic surgeons interested in shoulder problems and for increased accuracy of therapeutic injections using ultrasound guide. CONCLUSION: We would like to encourage more orthopaedic surgeons to take up shoulder ultrasonography as part of their routine examination of shoulder problems and also consider integrating shoulder ultrasound training to the residency and fellowship training programs. The benefits to the patients include savings in time and money and also more accurate therapeutic injections when needed.

amstring injuries in athletes are common, but isolated avulsion or tear of biceps femoris tendon are a rare occurrence. Only a few case reports have been published. McGoldrick 1,2 has been credited as the first to report a case of spontaneous rupture of biceps femoris. Since then, there have been several other reports. [2][3][4][5][6][7][8][9][10][11] We report a case of complete avulsion of distal biceps femoris tendon from head of fibula with a review of previously published cases of isolated rupture of biceps femoris tendon to look for patterns in epidemiology, mechanism of injury, location of tear, treatment methods and their outcome. Case ReportA 34-year-old Brazilian football (soccer) coach was admitted to the emergency room after he felt a sudden pain and a pop in the lateral side of his right knee after kicking a football backwards with his heel. He was not able to walk afterwards. Physical examination showed mild swelling and marked tenderness in the posterolateral part of his knee and fibula head. Full passive flexion or knee extension was not possible due to pain. Active movement of his knee was also very painful. There was no gross instability of the knee. Magnetic resonance imaging (MRI) scan showed avulsion of distal biceps femoris insertion at the head of the fibula with no other pathology (Figure 1).