No abstract

BackgroundA subungual glomus tumour is a rare benign neoplasm that develops in the distal portion of the finger from the glomus body. Hand surgeons are most significant in the diagnosis of this tumour. Case reportWe present an atypical case of a patient who experienced multiple recurrences of a subungual glomus tumour of the finger over a period of 26 years. A transungual approach was used to remove the nail during the surgical excision. Postoperatively, the patient was symptom-free. DiscussionThe glomus body is the neuromyoarterial histological structure located in the stratum reticularis of the dermis of the skin and the subungual regions. Recurrences can be classified as early, delayed and ancient. Early recurrences may result from incomplete excision or a second tumour that develops within a year of the initial excision. A year following excision, delayed recurrences are thought to be caused by a new glomus tumour at the fingertip. A tumour that reappears more than three times after excision on the same fingertip in five years can be either a new or incomplete excised tumour, as in our case, and is considered an ancient recurrence. Surgical eye loupes should be use intraoperatively to improve complete tumour lesion excision. ConclusionTo the best of our knowledge, this is the first case of a finger with five recurrences post excision. In the event that excision-related pain is significant, recurrence should be considered. Delayed and ancient recurrences are thought to be caused by a new glomus tumour at the fingertip that one cannot prevent with surgery.

Closed traumatic rupture of tendons at the musculotendinous junction occurs when there is a sudden longitudinal pull of the tendon against a contracting muscle as in resisted extension or flexion of a finger [1]. The weakest point in the whole musculotendinous unit is however at the distal insertion point of the tendon into bone as described by Boyes [2]. When considering the extensor tendons in isolation, the most closed ruptures occur at the insertion of the tendon on the distal phalanx or the attachment of the central slip at the base of the middle phalanx.Introduction: Closed traumatic rupture of extensor tendons of the fingers at the musculotendinous is rare. In fact the common sites of a closed rupture are distal attachment at the distal phalanx as well as at the attachment of the central slip at the base of the middle phalanx. The diagnosis of these injuries at the latter sites is straightforward. Case presentation: We present a 19 year-old right hand dominant motor mechanic male patient who sustained injury of his left forearm while swinging from gymnastic bars. He reports that while swinging, he felt a violent snap at the dorsum of his left forearm while his body swung down from a height. He thinks that the grip of the left hand did not release in time following the downward swing of his body. He presented few days after the injury complaining of pain, swelling and inability to actively extend the index finger. On surgical exploration, it was documented that both the extensor digitorium of the index as well as the extensor indicis proprius were torn at their musculotendinous junctions. Both tendons were sutured side to side before the resultant joined tendon was sutured to the extensor tendon of the middle finger. A below-elbow volar slab was applied for 6 weeks followed by hand therapy. The patient was seen for some time and came back only once for follow-up. At 8 months postoperatively, he was back to his work with full recovery demonstrating isolated index finger extension. Discussion: Closed traumatic rupture of the extensor tendons at the musculotendinous junction is very rare. This case serves to highlight, the peculiar mechanism of injury; the violent snap that results from the rupture and the presented clinical picture. Like this case, if surgery is done in time, a good outcome is to be expected when side-to-side suturing of the two tendons is done and the resultant joined tendon is sutured to the adjacent middle finger extensor tendon.