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  • ISSN: 2379-0571
    Current Issue
    Volume 4, Issue 6
    Case Report
    Ryan A. Sprouse* and Morgan Johnson
    There are numerous causes of median neuropathy at the wrist. Space occupying lesions within the carpal tunnel represent a minority of median neuropathy causes. We present a case of median neuropathy at the wrist caused by an occult ganglion cyst within the carpal tunnel. Our patient presented with two months of numbness and tingling of the volar thumb and second digit with one week of gradual onset of volar wrist swelling. On point-of-care ultrasound examination, there was a 2.0 x 0.8 x 1.8 cm fluid filled cyst within the carpal tunnel contacting the median nerve. Subsequently, an MRI of the wrist confirmed the size and location of the cyst, and that the cyst was consistent with a ganglion cyst. The patient followed up in the office where an ultrasound guided aspiration and corticosteroid injection of the cyst were performed. The patient followed up at two months and again at 6 months from the initial visit. She had significant improvement and continues to have only minimal symptoms. Our case illustrates the value of point-of-care ultrasound in evaluating masses in the carpal tunnel as a cause of median neuropathy at the wrist. Additionally, ultrasound guided ganglion cyst aspiration can serve as both an immediate and long term solution for median neuropathy caused by a compressing ganglion cyst.
    Research Article
    William J. Hill, Jeffery R. Ruland, and David R. Diduch*
    Spontaneous osteonecrosis of the knee (SONK) is a condition which is known to disproportionately affect women greater than sixty years old. The etiology of SONK is complex without a definitive consensus. The purpose of this paper is to discuss the etiology of SONK on a microscopic and macroscopic level. The patient populations at risk will be highlighted, as SONK can present in athletes and older patients. Staging and imaging studies are critical for understanding the progression of disease and deciding the appropriate treatment option. Non-surgical and surgical treatment options for SONK will be discussed.
    Review Article
    Scott M. Feeley*, Eric S. Larson, and David R. Diduch
    Adhesive capsulitis is a common disorder of the shoulder with unknown etiology. It presents with insidious onset of pain accompanied by progressive stiffness and loss of both active and passive range of motion. Adhesive capsulitis is a diagnosis of exclusion and can only be made once other pathologies have been ruled out. The progression and risk factors associated with the disease necessitate individualized patient approaches for pain reduction and functional improvements. This review outlines what is currently understood about the progression of the disease and what treatments have been shown to be efficacious. Despite decades of research into the underlying causes, progression, and treatment, much is still unknown about the condition. The pathology and risk factors for adhesive capsulitis should continue to guide further research to better understand the triggers for adhesive capsulitis and its treatment.
    Naomi E. Gadinsky, Dean G. Lorich, and Lionel E. Lazaro*
    Patients commonly report anterior knee pain (AKP) during daily activities following various knee surgeries including: (i) open reduction internal fixation (ORIF) of patellar fractures, (ii) total knee arthroplasty (TKA) and (iii) anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autograft. It is also known that the blood supply to the patella is disrupted during these surgical interventions. We therefore reviewed the literature to investigate the disruption of patellar blood supply as a potential source of AKP following various surgical interventions about the knee joint.
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