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IntroductionWe report the rare case of a patient presenting with dysphagia secondary to a large vertebral osteophyte, which formed from his previous occupation.Presentation of caseA 76-year-old gentleman presented with a year-long history of dysphagia to solids, at the laryngeal level. He was otherwise well, with no red-flag symptoms. Nasoendoscopy showed a left-sided bulge obstructing the piriform fossa. Barium swallow demonstrated a large C4/C5 vertebral osteophyte. Excluding other abnormalities the patient's dysphagia was determined to be due to the osteophyte. The patient mentioned carrying large (50 kg) bags of coal for his previous occupation. This chronic trauma was concluded to be the cause for the osteophyte.DiscussionWe use this case as an opportunity to outline mechanism of swallowing, and the causes and classification of dysphagia are additionally described. We also review the literature regarding vertebral osteophytes to contextualise the rarity of this case, especially in regard to the strong occupational association.ConclusionA structured and thorough history and examination in dysphagia is emphasized. It is important to enquire about ‘red-flag’ symptoms, suggestive of head and neck or upper gastrointestinal malignancy. Barium swallow is a critical investigation in dysphagia-it can also demonstrate large bony abnormalities, which is a rare causative factor.

Background: Lateral epicondylitis (LE) occurs in almost half of all tennis players. Racket-string tension is considered to be an important factor influencing the development of LE. No literature yet exists that substantiates how string-tension affects force transmission to the elbow, as implicated in LE development. We establish a quantitative relationship between string-tension and elbow loading, analyzing tennis strokes using rackets with varying string-tensions. Methods: Twenty recreational tennis players simulated backhand tennis strokes using three rackets strung at tensions of 200 N, 222 N and 245 N. Accelerometers recorded accelerations at the elbow, wrist and racket handle. Average peak acceleration was determined to correlate string-tension with elbow loading. Results: Statistically significant differences (p < 0.05) were observed when average peak acceleration at the elbow at 200 N string-tension (acceleration of 5.58 m/s 2 ) was compared with that at 222 N tension (acceleration of 6.83 m/s 2 ) and 245 N tension (acceleration of 7.45 m/s 2 ). The 200 N racket induced the least acceleration at the elbow. Conclusions: Although parameters determining force transmission to the elbow during a tennis stroke are complex, the present study was able to control these parameters, isolating the effect of string-tension. Lower string-tensions transmit less force to the elbow in backhand strokes. Reducing string-tension should be considered favourably with respect to reducing the risk of developing LE.

IntroductionMucous cyst is the commonest soft tissue tumor in the dorsum of the distal interphalangeal joint (DIPJ) of the finger. We report the first case of a recurring eccrine tumor (nodular hidradenoma), mimicking a mucous/ganglion cyst, on the dorsum of the DIPJ.Case reportA 54 year old man presented with painless, hemispherical, colored swelling on the dorsum of his right middle finger (dominant hand), which appeared to have recurred from a previous surgery. The lesion was excised and operative findings from the medical notes showed the gross appearance to be a soft, white, glistening, smooth-surfaced, myxoid nodule resembling a “ganglion cyst”. Immunohistochemistry showed the tumour to be positive for S100, smooth muscle actin and cytokeratin 7. Ductal differentiation was confirmed by staining for epithelial membrane antigen and carcinoembryonic antigen. The histological features were that of atypical and solid cystic hidradenoma.DiscussionThis is the first reported case of this rare tumour presenting as mucous cyst. We conduct a review of the literature of nodular hidradenomas, illustrating the immunohistologic findings in this tumour to emphasise the atypical features.We emphasise the importance of considering hidradenoma in the differential diagnosis of such lesions of the finger, in view of its high recurrence rate and the possibility of malignant transformation.