Sunil Garg - Academia.edu (original) (raw)

Papers by Sunil Garg

The Lancet, 2020

Background Manipulation under anaesthesia and arthroscopic capsular release are costly and invasi... more Background Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection. Methods In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.

Journal of Bone and Joint Surgery-british Volume, 2014

Background Nonsurgical treatment of Acromioclavicular joint dislocations is well established. Mos... more Background Nonsurgical treatment of Acromioclavicular joint dislocations is well established. Most patients treated conservatively do well, however, some of them develop persistent symptoms. We have used two different surgical reconstruction techniques for Chronic ACJ dislocation stabilization. The study evaluates the effectiveness of a braided polyester prosthetic ligament and modified Weaver-Dunn reconstruction methods. Methods 55 patients (mean age 42) with Chronic Acromioclavicular joint dislocation were included in this study. They were treated either by a modified Weaver-Dunn method or a braided polyester prosthetic ligament. Patients were assessed using Oxford shoulder score preoperatively and a minimum of 12 months postoperatively. Results 31 patients (mean age 40, M=24, F=7) were treated by Modified WD method and 24 patients (mean age 44, M=18, F=6) by Surgilig at a mean21 and 24 months post injury. The mode of injury, presentation of symptoms, grade of injury and mean time...

Journal of orthopaedic surgery (Hong Kong), 2014

PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using ... more PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament. METHODS. 55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded. RESULTS. After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93...

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an exce... more Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofib...

Journal of Bone Joint Surgery British Volume, May 1, 2009

Complex proximal humerus fractures have been described as the unsolved fracture. Review of litera... more Complex proximal humerus fractures have been described as the unsolved fracture. Review of literature shows a variety of treatment methods and results. We present the results of a prospective study of 47 complex proximal humerus fractures treated by PHILOS (Proximal Humeral Internal Locking System) plate. The aim of this study was to assess the effectiveness of the PHILOS plate in the surgical treatment of Neer’s type 3 & 4 fractures. We operated upon 47 patients (mean age 56yrs) between March 2002 and January 2006 for fixation of 3 part (28 patients) and 4 part (19 patients) fractures at a level 1 trauma centre. An independent observer reviewed patients at 6 monthly intervals for clinical and radiological assessment. Outcome measures included DASH and Constant scores. 42 patients were available for follow up, which ranged from 12–66 (average 24.4) months. Recovery of movements, and relief in pain was satisfactory in most of the patients, but the strength of shoulder did not recover fully in any patient. There were two failures in our series, one due to breakage of plate and another due to non-union; both treated successfully by revision. 4 patients (8%) had radiological signs of avascular necrosis of humeral head but only 2 of them were symptomatic requiring further treatment. Pain due to impingement was noted in several patients leading to removal of plate (6 patients) and subacromial decompression (3 patients). We encountered the problem of cold welding and distortion of screw heads, while removing the plate. The broken plate was subjected to biomechanical and metallurgical analysis, which revealed that the plate is inherently weak at the site of failure. We concluded that in spite of the above-mentioned complications, the PHILOS plate is a reliable implant to fix 3 and 4 part proximal humeral fractures. We were particularly impressed with the satisfactory results of fixation in 4 part fractures. However, we are not convinced about its strength. The plate may cause impingement in some patients necessitating its removal later on, which itself may not be easy. Level of Evidence: Therapeutic study, level IV (case series).

International Journal of Shoulder Surgery, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Shoulder & Elbow, 2011

Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000... more Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000,000 [1] of the population, with almost full penetrance by the age of 20 years [2]. It selectively affects the muscles of the face and the shoulder and particularly those that stabilize the ...

Hand Surgery, 2011

We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy wi... more We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy with pyrocarbon interposition in 38 consecutive patients with trapeziometacarpal joint osteoarthrosis. Patients were assessed preoperatively, at six and 12 months postoperatively using subjective and objective tools. Subjective assessment was performed using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the visual analogue score. Objective assessment was performed with grip strength measurements. At each time interval, statistical differences were sought between the two subgroups. No significant difference between the two subgroups was noted at any time interval on subjective or objective assessment. A significant difference (p < 0.05) was found on comparing the respective preoperative and 12-month subjective scores in both subgroups. Of the pyrocarbon subgroup seven had related complications. We suggest that pyrocarbon interposition does not significantly impr...

Open Journal of Orthopedics, 2014

Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with... more Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia; that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty); twenty-three procedures were completed (82.14%); no patient required conversion to another form of anaesthesia either general or spinal; five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.

Journal of Shoulder and Elbow Surgery, 2012

Journal of Hand Surgery (European Volume), 2009

Journal of shoulder and …, 2011

1. J Shoulder Elbow Surg. 2011 Oct 15. [Epub ahead of print] Posterior sternoclavicular joint dis... more 1. J Shoulder Elbow Surg. 2011 Oct 15. [Epub ahead of print] Posterior sternoclavicular joint dislocation in a child: a case report with review of literature. Garg S, Alshameeri ZA, Wallace WA. Nottingham Shoulder and Elbow ...

Cases Journal, 2009

We report a case of an angioleiomyoma occurring in a 40-year-old Kenyan female. The patient prese... more We report a case of an angioleiomyoma occurring in a 40-year-old Kenyan female. The patient presented with recurrent pain and a soft tissue swelling at the posteromedial aspect of her right knee. Angioleiomyomas are benign soft tissue tumours, which occur most commonly in the skin of the lower extremities in middle-aged females. They very rarely occur in the knee and are treated curatively with resection. A brief literature review is included.

Journal of Hand Surgery ( …, 2009

An ultrasound scan of the left wrist confirmed a well-circumscribed focal lesion, which appeared ... more An ultrasound scan of the left wrist confirmed a well-circumscribed focal lesion, which appeared to lie within the median nerve, displacing its fibres. To avoid any delay in treatment, no further investiga-tions were requested and the patient underwent immedi-ate explorative ...

Shoulder & Elbow, 2011

Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000... more Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000,000 [1] of the population, with almost full penetrance by the age of 20 years [2]. It selectively affects the muscles of the face and the shoulder and particularly those that stabilize the ...

Cases Journal, 2009

Angioleiomyomas, or vascular leiomyomas, are infrequent benign tumours originating from smooth mu... more Angioleiomyomas, or vascular leiomyomas, are infrequent benign tumours originating from smooth muscle cells of arterial or venous walls. They were first described in 1937 by Stout AP [1], and since then several authors have published successive opinions regarding their origins. ...

Annals of Plastic Surgery, 2010

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an exce... more Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma is included.

Journal of Orthopaedic Surgery and …

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an exce... more Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a ...

Hand surgery: an …, 2011

We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy wi... more We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy with pyrocarbon interposition in 38 consecutive patients with trapeziometacarpal joint osteoarthrosis. Patients were assessed preoperatively, at six and 12 months ...

Cases Journal, 2009

We report a rare case of a 'giant ganglion' with 24 × 10 × 12 cm dimensions originating... more We report a rare case of a 'giant ganglion' with 24 × 10 × 12 cm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass in his left calf located between the superior aspect of the popliteal fossa and the distal third ...

The Lancet, 2020

Background Manipulation under anaesthesia and arthroscopic capsular release are costly and invasi... more Background Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection. Methods In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.

Journal of Bone and Joint Surgery-british Volume, 2014

Background Nonsurgical treatment of Acromioclavicular joint dislocations is well established. Mos... more Background Nonsurgical treatment of Acromioclavicular joint dislocations is well established. Most patients treated conservatively do well, however, some of them develop persistent symptoms. We have used two different surgical reconstruction techniques for Chronic ACJ dislocation stabilization. The study evaluates the effectiveness of a braided polyester prosthetic ligament and modified Weaver-Dunn reconstruction methods. Methods 55 patients (mean age 42) with Chronic Acromioclavicular joint dislocation were included in this study. They were treated either by a modified Weaver-Dunn method or a braided polyester prosthetic ligament. Patients were assessed using Oxford shoulder score preoperatively and a minimum of 12 months postoperatively. Results 31 patients (mean age 40, M=24, F=7) were treated by Modified WD method and 24 patients (mean age 44, M=18, F=6) by Surgilig at a mean21 and 24 months post injury. The mode of injury, presentation of symptoms, grade of injury and mean time...

Journal of orthopaedic surgery (Hong Kong), 2014

PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using ... more PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament. METHODS. 55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded. RESULTS. After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93...

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an exce... more Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofib...

Journal of Bone Joint Surgery British Volume, May 1, 2009

Complex proximal humerus fractures have been described as the unsolved fracture. Review of litera... more Complex proximal humerus fractures have been described as the unsolved fracture. Review of literature shows a variety of treatment methods and results. We present the results of a prospective study of 47 complex proximal humerus fractures treated by PHILOS (Proximal Humeral Internal Locking System) plate. The aim of this study was to assess the effectiveness of the PHILOS plate in the surgical treatment of Neer’s type 3 & 4 fractures. We operated upon 47 patients (mean age 56yrs) between March 2002 and January 2006 for fixation of 3 part (28 patients) and 4 part (19 patients) fractures at a level 1 trauma centre. An independent observer reviewed patients at 6 monthly intervals for clinical and radiological assessment. Outcome measures included DASH and Constant scores. 42 patients were available for follow up, which ranged from 12–66 (average 24.4) months. Recovery of movements, and relief in pain was satisfactory in most of the patients, but the strength of shoulder did not recover fully in any patient. There were two failures in our series, one due to breakage of plate and another due to non-union; both treated successfully by revision. 4 patients (8%) had radiological signs of avascular necrosis of humeral head but only 2 of them were symptomatic requiring further treatment. Pain due to impingement was noted in several patients leading to removal of plate (6 patients) and subacromial decompression (3 patients). We encountered the problem of cold welding and distortion of screw heads, while removing the plate. The broken plate was subjected to biomechanical and metallurgical analysis, which revealed that the plate is inherently weak at the site of failure. We concluded that in spite of the above-mentioned complications, the PHILOS plate is a reliable implant to fix 3 and 4 part proximal humeral fractures. We were particularly impressed with the satisfactory results of fixation in 4 part fractures. However, we are not convinced about its strength. The plate may cause impingement in some patients necessitating its removal later on, which itself may not be easy. Level of Evidence: Therapeutic study, level IV (case series).

International Journal of Shoulder Surgery, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Shoulder & Elbow, 2011

Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000... more Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000,000 [1] of the population, with almost full penetrance by the age of 20 years [2]. It selectively affects the muscles of the face and the shoulder and particularly those that stabilize the ...

Hand Surgery, 2011

We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy wi... more We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy with pyrocarbon interposition in 38 consecutive patients with trapeziometacarpal joint osteoarthrosis. Patients were assessed preoperatively, at six and 12 months postoperatively using subjective and objective tools. Subjective assessment was performed using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the visual analogue score. Objective assessment was performed with grip strength measurements. At each time interval, statistical differences were sought between the two subgroups. No significant difference between the two subgroups was noted at any time interval on subjective or objective assessment. A significant difference (p < 0.05) was found on comparing the respective preoperative and 12-month subjective scores in both subgroups. Of the pyrocarbon subgroup seven had related complications. We suggest that pyrocarbon interposition does not significantly impr...

Open Journal of Orthopedics, 2014

Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with... more Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia; that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty); twenty-three procedures were completed (82.14%); no patient required conversion to another form of anaesthesia either general or spinal; five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.

Journal of Shoulder and Elbow Surgery, 2012

Journal of Hand Surgery (European Volume), 2009

Journal of shoulder and …, 2011

1. J Shoulder Elbow Surg. 2011 Oct 15. [Epub ahead of print] Posterior sternoclavicular joint dis... more 1. J Shoulder Elbow Surg. 2011 Oct 15. [Epub ahead of print] Posterior sternoclavicular joint dislocation in a child: a case report with review of literature. Garg S, Alshameeri ZA, Wallace WA. Nottingham Shoulder and Elbow ...

Cases Journal, 2009

We report a case of an angioleiomyoma occurring in a 40-year-old Kenyan female. The patient prese... more We report a case of an angioleiomyoma occurring in a 40-year-old Kenyan female. The patient presented with recurrent pain and a soft tissue swelling at the posteromedial aspect of her right knee. Angioleiomyomas are benign soft tissue tumours, which occur most commonly in the skin of the lower extremities in middle-aged females. They very rarely occur in the knee and are treated curatively with resection. A brief literature review is included.

Journal of Hand Surgery ( …, 2009

An ultrasound scan of the left wrist confirmed a well-circumscribed focal lesion, which appeared ... more An ultrasound scan of the left wrist confirmed a well-circumscribed focal lesion, which appeared to lie within the median nerve, displacing its fibres. To avoid any delay in treatment, no further investiga-tions were requested and the patient underwent immedi-ate explorative ...

Shoulder & Elbow, 2011

Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000... more Fascio-scapulo-humeral dystrophy (FSHD) is a rare autosomal dominant disease affecting 7 in 1,000,000 [1] of the population, with almost full penetrance by the age of 20 years [2]. It selectively affects the muscles of the face and the shoulder and particularly those that stabilize the ...

Cases Journal, 2009

Angioleiomyomas, or vascular leiomyomas, are infrequent benign tumours originating from smooth mu... more Angioleiomyomas, or vascular leiomyomas, are infrequent benign tumours originating from smooth muscle cells of arterial or venous walls. They were first described in 1937 by Stout AP [1], and since then several authors have published successive opinions regarding their origins. ...

Annals of Plastic Surgery, 2010

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an exce... more Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma is included.

Journal of Orthopaedic Surgery and …

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an exce... more Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a ...

Hand surgery: an …, 2011

We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy wi... more We performed a prospective cohort comparative analysis of simple trapezectomy and trapezectomy with pyrocarbon interposition in 38 consecutive patients with trapeziometacarpal joint osteoarthrosis. Patients were assessed preoperatively, at six and 12 months ...

Cases Journal, 2009

We report a rare case of a 'giant ganglion' with 24 × 10 × 12 cm dimensions originating... more We report a rare case of a 'giant ganglion' with 24 × 10 × 12 cm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass in his left calf located between the superior aspect of the popliteal fossa and the distal third ...