Compartment syndrome refers to a condition of compromised circulation within a limited space due to increased pressure within that space. The reduced tissue perfusion results in reduced venous drainage, leading to increased interstitial tissue pressure and subsequent compromised arterial flow. Although not as common as compartment syndrome of the leg and forearm, compartment syndrome of the hand is not rare and can lead to devastating sequelae as a result of tissue necrosis. Compartment syndrome of the hand has several etiologies, including trauma, arterial injury, thermal injury, and constrictive bandaging. The cardinal clinical sign is pain that is aggravated by passive stretching of the muscles within the involved compartments. Extremity function is usually restored with expeditious fasciotomy of the involved myofascial compartments, and complications, such as intrinsic muscular dysfunction and Volkmann's ischemic contracture, can usually be prevented. There are no reported cases of compartment syndrome of the hand in patients with systemic sclerosis or Raynaud's phenomenon. Systemic sclerosis is a form of scleroderma that affects the skin and internal organs. The limited cutaneous subset affects the skin of the extremities but is associated with a set of characteristic features that includes calcinosis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia. This report describes an unusual case of a patient who had spontaneous compartment syndrome of the hand. The patient's concomitant limited cutaneous systemic sclerosis may have played a role in this unusual occurrence. The diagnosis was based on the clinical picture, and the symptoms resolved after surgical decompression.

Background: Clavicle fractures are common, with an overall incidence of 36.5 -64 per 100,000 people every year. Traditionally, midshaft clavicle fractures have been treated nonoperatively. Recently, there has been increasing interest in the operative treatment and plate fixation or intramedullary nailing is often the treatment modality of choice. Numerous clinical studies have been published to compare surgical and conservative treatments. The best treatment for displaced midshaft clavicle fractures remains a topic of debate. So We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Objectives: To compare functional outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Materials and Methods: 60 patients with a displaced midshaft fracture of the clavicle who were presented to RL Jalappa Hospital from June 2015 to October 2016 and either treated by conservative or operative methods of treatment and who were in regular follow up are selected. Functional assessment was done at 6 weeks, 3 months and 6 months with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores Complications, if any will be recorded. Results: DASH Scores and Constant scores were significantly better in the operative group compared to the conservative group at all time points. Conclusion: Operative treatment resulted in early return to function compared to conservative treatment but at the cost if complications like infection and other hardware related problems.

Carpal tunnel syndrome (CTS) is a condition in which there is median nerve entrapment within the carpal tunnel. The carpal tunnel is a small space in which nine tendons and the median nerve pass. Some authors consider it a closed space as it can behave as a closed compartment, and the median nerve may be affected by increased intracompartmental pressure. 1 Chronic CTS is the common form and can be treated conservatively or surgically. Conservative treatment is in the form of splinting, anti-inflammatory medication, and steroid injections (blind or ultrasound guided), while surgical is in the form of decompression (open or endoscopic). 2 On the other hand, acute CTS is rare. It is characterized by rapid progressive symptoms that arise in a matter of hours. It is mainly caused by fractures and/or dislocations around the wrist joint and less commonly caused by nontraumatic causes such as bleeding due to a bleeding disorder or from anticoagulant therapy. Acute CTS is a surgical emergency and requires urgent decompression to prevent undesired complications. 3 We present a case in which a patient suffered from iatrogenic acute CTS following a steroid injection to relief the symptoms of moderate CTS. The patient was a 43 year-old right-handed female dental nurse. She was complaining of tingling and numbness affecting the radial three digits for the last 12 months. Her symptoms progressed over the last 2 months, with increasing nocturnal pain, tingling, and numbness not responding to splints and anti-inflammatory medication. A nerve conduction study was organized and it showed mild-to-moderate CTS. The patient was injected 1 mL of 40-mg methylprednisolone þ 1 mL (0.25%) levobupivacaine into the carpal tunnel. The patient returned 24 hours later with worsening symptoms. She was referred to the accident & emergency department with worsening pain, numbness, and global hand weakness not responding to simple measures such as elevation and splintage. On examination, the patient was in severe pain at rest, paresthesia over the median nerve distribution, and weakness of the abductor pollicis brevis (Medical Research Council grade 3). Passive movement of the thumb, index, and middle fingers resulted in excruciating pain. There were no signs of infection at presentation. The clinical picture was consistent with acute CTS and urgent decompression was performed through an extended approach into the distal forearm. Intraoperatively, the median nerve sheath was swollen with chalky white powder deposits. There were no signs of nerve damage or infection. Serous fluid oozing from the nerve sheath was sent for Gram stain, culture, and sensitivity testing. No organisms were seen or grown from it. The patient had immediate relief of her median nerve symptoms postoperatively. The following day the patient was able to actively move the wrist, thumb, and fingers with minimal pain. The patient was followed up 2 weeks later. She had regained full muscle power strength and had normal sensation at that stage.Steroid injections are frequently us...

To the best of our knowledge, this is the first case report describing Mycobacterium chelonae osteomyelitis of the first metatarsal ray in an immunocompetent individual. This diagnosis should be considered in patients with osteomyelitis that persists despite the use of broad-spectrum antibiotics, even in healthy individuals.