Reflex sympathetic dystrophy: misdiagnosis in patients with dysfunctional postures of the upper extremity

The purpose of this case-control study was to assess the frequency of the inappropriate diagnosis of reflex sympathetic dystrophy (RSD) in patients who presented with dysfunctional postures of the upper extremity (n = 43). This group of patients with a dysfunctional posture was compared with a randomly selected control group of patients who presented with pain but no dysfunctional posture (n = 88). The patients underwent radiographic evaluation after review of previous medical records and history and physical examination. Patients with dysfunctional postures had a significantly higher frequency (63%) of a previous inappropriate diagnosis of RSD compared with the control group (6%). None of the patients in either group had objective findings consistent with a diagnosis of RSD. Patients presenting with dysfunctional postures of the upper extremity may be misdiagnosed as having RSD and rarely meet the criteria for this diagnosis.

Psychosocial aspects of hand injuries and diseases

More than 50% of patients with a diagnosable psychiatric disorder initially present with somatic symptoms, which often effectively distract the physician from the true illness. Moreover, the occupational setting is ripe for the emergence of psychosocial issues.

One-stage reconstruction of the nailfold

Management of nailfold deformity is a difficult problem, with only seven documented techniques of reconstruction to date. We report 17 who underwent nailfold reconstruction with use of a one-stage, dorsal rotational flap with full thickness skin graft. Results show increases in range of motion and improved nail appearance.

Disability: a new psychosocial perspective

A previously disabled family member is presented as a psychosocial determinant in the subsequent disability of the patient. Eighty-three disabled patients presented for an independent medical examination of the upper extremity. All were seeking a workers' compensation settlement or continued workers' compensation benefits. Patients were questioned regarding the current disability of any family member(s). Forty-four of the 83 had at least one family member who was disabled and 36 had experienced a traumatic incident or injury resulting in workers' compensation. Forty-seven had no objective impairment. These findings suggest a significant correlation between the "disabled" support system and subsequent disability of the patient (P < .001).

Sebaceous gland carcinoma of the finger

We report a patient with sebaceous gland carcinoma of the finger. Sebaceous gland carcinomas located outside the ocular adnexa are rare, with fewer than 100 cases documented to date. The majority of these arise in the head and neck where sebaceous glands are plentiful. Because this tumor shows no pathognomonic characteristics, accurate histologic evaluation is essential to its diagnosis. Local excision may not be adequate treatment for a sebaceous gland carcinoma of the digit. Ray amputation was the treatment of choice for this patient.