OKOJ, Volume 7, No. 5

Hallux Rigidus: Clinical Presentation and Management of the Stiff Great Toe

Hallux rigidus encompasses a spectrum of articular cartilage degeneration of the first metatarsophalangeal (MTP) joint. Patients usually present with a painful, stiff great toe with dorsal impinging osteophytes that restrict dorsiflexion and passive motion. Multiple conservative and surgical treatments are available for the management of hallux rigidus. Nonsurgical treatments for hallux rigidus aim to decrease synovial irritation and/or decrease motion at the great toe MTP joint via medication, injection, orthosis, shoe wear modification, and activity adjustment. If conservative management fails, then surgical treatment is selected according to the clinical and radiographic findings and the patient's goals and expectations. Surgical procedures are designed to preserve joint motion, resurface the joint to create motion, or eliminate joint motion. In patients with grade 1 or 2 (and sometimes those with grade 3) hallux rigidus, cheilectomy is a useful treatment option with good outcomes. In younger or active patients with higher grades or more diffuse joint involvement, arthrodesis is recommended. Resection arthroplasty (Keller procedure) or interpositional arthroplasty is indicated for older, low-demand patients. At this time, prosthetic replacement is not recommended for routine use.

    • Keywords:
    • hallux rigidus

    • stiff great toe

    • stiff big toe

    • hallux flexus

    • hallux limitus

    • metatarsus primus elevatus

    • hallux dolorosus

    • Winkle Pinckers disease

    • Subspecialty:
    • Foot and Ankle

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper extremity. It describes a clinical syndrome commonly involving pain, weakness, paresthesias, and/or numbness caused by compression of the median nerve as it passes through the fibro-osseous carpal tunnel at the level of the wrist. The etiology of CTS is likely multifactorial, and diagnosis is made primarily on the basis of a thorough patient history and physical examination. For patients with mild symptoms, a variety of nonsurgical treatments have been shown to be effective in providing relief, including splinting, oral medications, and corticosteroid injection. When conservative treatment fails or a patient presents with advanced neuropathy, surgical intervention is recommended. Whether performed open or endoscopically, surgical release of the carpal tunnel has produced consistently excellent clinical results over the past several decades.

    • Keywords:
    • CTS

    • median nerve compression at the wrist

    • compressive neuropathy

    • median nerve entrapment

    • median neuropathy

    • median nerve compression syndrome

    • Subspecialty:
    • Hand and Wrist

Aneurysmal Bone Cyst

Aneurysmal bone cyst (ABC) is a benign but locally aggressive bone tumor that most frequently involves the long bones of the extremities, pelvis, and the posterior elements of the spine. ABCs comprise 1% to 6% of all primary bone tumors and have an overall prevalence of 0.32 per 100,000 individuals. There is an equal prevalence among genders, and the median age at presentation is 11.1 years. The true etiology and natural history of ABCs are not well understood, but there is consensus that thorough intralesional curettage and removal of the entire tumor must be performed to minimize the risk of local recurrence. Other treatment options include en bloc excision, selective arterial embolization, external beam radiation therapy, and curettage with locally applied adjuvant therapy, such as argon beam coagulation, liquid nitrogen, phenol, or hydrogen peroxide.

    • Keywords:
    • ABC

    • primary aneurysmal bone cyst

    • primary ABC

    • benign neoplasm of bone

    • secondary aneurysmal bone cyst

    • secondary ABC

    • giant cell tumor

    • osteoblastoma

    • angioma

    • chondroblastoma

    • selective arterial embolization

    • intralesional curettage

    • Subspecialty:
    • Musculoskeletal Oncology