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LETTERS TO THE EDITOR
Letter Regarding “Linburg-Comstock Anomaly” To the Editor: We read with interest this In Brief article in the August 2014 issue of the Journal.1 In our experience, the finding of a functional connection between the index finger flexor digitorum profundus and the flexor pollicis longus is common, but a pathological connection causing pain or neurological deficit is rare. The anomalous connection causes chronic thickened tenosynovial encasement of the flexor tendons. Neurological manifestations can occur due to increased carpal tunnel contents either from the synovial membranes or intertendinous connections. This results in classic nocturnal symptoms, but also in symptoms after exercise probably due to increased blood flow and tissue edema. Simple median nerve decompression may result in resolution of the neurological symptoms and pain. In our experience, some patients may present with sudden severe neurological symptoms during activities that result from differential gliding of the index finger flexor digitorum profundus and the flexor pollicis longus tendons. These patients may have no or limited relief from carpal tunnel decompression. This represents traction neuropathy due to encasement of the median
nerve and tether to the index finger flexor digitorum profundus and flexor pollicis longus in the distal forearm. Careful examination will identify these patients’ pathology and a diagnostic local anaesthetic injection2 at this site may help to establish the diagnosis of traction neuropathy. We have successfully treated these patients with combined tenolysis and external neurolysis of the median nerve at this site. Dominic Power, MB BCh Deepak Samson, MBBS MS Mohammad Nassimizadeh, MB BCh Centre for Nerve Nerve Injury and Paralysis Queen Elizabeth University Hospital Birmingham, UK http://dx.doi.org/10.1016/j.jhsa.2014.09.029
REFERENCES 1. Gancarczyk SM, Strauch RJ. Linburg-Comstock anomaly. J Hand Surg Am. 2014;39(8):1620e1622. 2. Puroshothaman B, Power D. A simple diagnostic test for symptomatic Linburg-Comstock anomaly. Internet J Hand Surg. 2008;2(2).
ERRATUM
In the article by Malay S and Chung KC in the November 2014 issue of the Journal (“Testing the Validity of Preventing Chronic Regional Pain Syndrome With Vitamin C After Distal Radius Fracture”, Vol. 39A, No. 11, pp 2251e2257), the title is incorrect. The article title should be “Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture.”
J Hand Surg Am.
r
Vol. 39, December 2014
LETTERS TO THE EDITOR
Letter Regarding “Linburg-Comstock Anomaly” To the Editor: We read with interest this In Brief article in the August 2014 issue of the Journal.1 In our experience, the finding of a functional connection between the index finger flexor digitorum profundus and the flexor pollicis longus is common, but a pathological connection causing pain or neurological deficit is rare. The anomalous connection causes chronic thickened tenosynovial encasement of the flexor tendons. Neurological manifestations can occur due to increased carpal tunnel contents either from the synovial membranes or intertendinous connections. This results in classic nocturnal symptoms, but also in symptoms after exercise probably due to increased blood flow and tissue edema. Simple median nerve decompression may result in resolution of the neurological symptoms and pain. In our experience, some patients may present with sudden severe neurological symptoms during activities that result from differential gliding of the index finger flexor digitorum profundus and the flexor pollicis longus tendons. These patients may have no or limited relief from carpal tunnel decompression. This represents traction neuropathy due to encasement of the median
nerve and tether to the index finger flexor digitorum profundus and flexor pollicis longus in the distal forearm. Careful examination will identify these patients’ pathology and a diagnostic local anaesthetic injection2 at this site may help to establish the diagnosis of traction neuropathy. We have successfully treated these patients with combined tenolysis and external neurolysis of the median nerve at this site. Dominic Power, MB BCh Deepak Samson, MBBS MS Mohammad Nassimizadeh, MB BCh Centre for Nerve Nerve Injury and Paralysis Queen Elizabeth University Hospital Birmingham, UK http://dx.doi.org/10.1016/j.jhsa.2014.09.029
REFERENCES 1. Gancarczyk SM, Strauch RJ. Linburg-Comstock anomaly. J Hand Surg Am. 2014;39(8):1620e1622. 2. Puroshothaman B, Power D. A simple diagnostic test for symptomatic Linburg-Comstock anomaly. Internet J Hand Surg. 2008;2(2).
ERRATUM
In the article by Malay S and Chung KC in the November 2014 issue of the Journal (“Testing the Validity of Preventing Chronic Regional Pain Syndrome With Vitamin C After Distal Radius Fracture”, Vol. 39A, No. 11, pp 2251e2257), the title is incorrect. The article title should be “Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture.”
J Hand Surg Am.
r
Vol. 39, December 2014
