Prompt, accurate identification of inflammatory arthritis can reduce patient morbidity and health care costs. However, internal medicine residents often do not receive adequate training in how to conduct an effective hand musculoskeletal examination. We created a short interactive workshop to teach the hand exam using our low-cost, easy-to-make 3-dimensional hand model for inflammatory arthritis.

Upper extremity burns comprise a significant proportion of severe burn injuries. Their effective management necessitates a multidisciplinary approach, with early integration of hand surgery specialists. This is a narrative review article of current treatment modalities, prioritizing strategies to minimize acute-phase complications and optimize long-term outcomes. We cover initial management principles including resuscitation, thorough secondary assessment, and prompt debridement; elaborate on reconstructive surgical interventions such as skin grafting and flap techniques, paying close attention to strategies that preserve key anatomic locations for good functional outcomes; and outline common complications such as infection, heterotopic ossification, scar contractures, edema, and compartment syndrome, providing evidence-based prevention and treatment strategies. Although the management of upper extremity burn patients can be complex, utilizing a standardized and meticulous approach to the management of these devastating injuries can result in significantly improved functionality of the upper extremity.

To compare the efficacy and safety of intense pulsed light (IPL) versus diode laser (DL) for female axillary hair removal in a randomized split-body trial. Women with Fitzpatrick skin types I-IV received IPL (690-nm filter) and DL (810 nm) on contralateral axillae with randomized side assignment. Four monthly sessions were performed. The primary outcome was hair count in a standardized 4-cm[2] area. Secondary outcomes included hair shaft thickness, pain intensity (numeric rating scale), participant satisfaction, evaluator-rated improvement (modified GAIS), quality of life (WHOQOL-bref), and adverse events. Participants and outcome assessors were blinded to side allocation. Forty-eight participants initiated treatment; 36 completed all sessions and 28 attended the 4-week post-treatment assessment (S4). Hair counts and hair shaft thickness decreased significantly over time with both modalities. At S4 (primary endpoint), the intention-to-treat analysis showed no statistically significant between-modality difference in hair counts; at 30-week (around 7 months) follow-up, DL showed more favorable objective outcomes (lower hair counts and thinner residual shafts). Pain scores were consistently higher with DL. Adverse-event profiles differed: erythema was more frequent with IPL, whereas perifollicular edema and carbonization were more frequent with DL; events were transient and required no medical intervention. Exploratory stratification by Fitzpatrick skin type showed no consistent pattern of increased adverse events in higher skin types. Satisfaction favored DL, while WHOQOL-bref scores did not change significantly. IPL and DL were both safe and effective for axillary hair removal in women with Fitzpatrick skin types I-IV. DL yielded more favorable longer-term objective outcomes but greater discomfort and transient procedure-related adverse effects. Trial registration: NCT06179186, 23 December 2023.

Aquagenic wrinkling of the palms (AWP) is a rare dermatologic condition characterized by rapid wrinkling, edema, and papules on the palms after brief water exposure. It is commonly associated with cystic fibrosis (CF) or CF carrier status but can also occur in individuals without these conditions. We report a healthy 12-year-old girl who presented with AWP without a family history of CF or related symptoms. After 4 minutes of water immersion, she exhibited typical wrinkling and translucent papules on the palms, which resolved completely within 15 minutes. A sweat test for CF was negative. The patient was managed with moisturizers and advised to minimize prolonged water exposure. This case highlights AWP as a potential early marker for CF or carrier status, even in the absence of other symptoms. Recognition of AWP may guide genetic screening and early intervention, underscoring the role of dermatologists in identifying this condition and facilitating timely diagnosis and management of CF.

Neck swelling with upper-extremity edema in a cancer patient presenting to the emergency department (ED) is a concerning clinical picture that may indicate underlying venous obstruction or malignancy. A 74-year-old woman developed a rapidly enlarging left supraclavicular mass after core needle biopsy of a lesion later diagnosed as high-grade follicular large B-cell lymphoma. Follow-up imaging initially suggested a postprocedural hematoma; however, bedside Doppler ultrasound in the emergency department demonstrated internal vascular flow, prompting repeat contrast-enhanced computed tomography (CT), which confirmed aggressive tumor progression with venous compression rather than bleeding. The patient was admitted for emergent inpatient Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) chemotherapy, which resulted in rapid symptomatic improvement and complete metabolic remission. This case highlights the diagnostic ambiguity of rapid postbiopsy enlargement of malignant neck masses and underscores the importance of bedside ultrasound, multidisciplinary evaluation, and reconsideration of initial imaging interpretations to avoid delays in definitive therapy.

A 55-year-old man with uncontrolled diabetes presented with progressive length-dependent weakness, numbness, and paresthesia, leading to profound upper extremity weakness and lower extremity paraplegia in 4 months. A review of systems additionally revealed leg edema, chest wall erythema, and weight loss. Nerve conduction study/electromyography (NCS/EMG) showed axonal length-dependent sensorimotor polyneuropathy. Additional testing revealed a rare etiology. Treatment was started, and the patient's symptoms stabilized. This report discusses the diagnostic approach to rapidly progressive polyneuropathies, emphasizing careful systemic examination, laboratory studies, imaging, and electrophysiologic testing. It also highlights the importance of looking beyond neurologic signs to identify systemic evidence of disease involvement.

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity and results from compression of the median nerve within the fibro-osseous carpal tunnel. Anatomical variants such as a bifid median nerve (BMN) and a persistent median artery (PMA) may increase tunnel occupancy and complicate both diagnosis and treatment. High-resolution musculoskeletal ultrasound enables detailed evaluation of these anatomical variations and facilitates image-guided interventions. Ultrasound-guided hydrodissection has emerged as a minimally invasive technique capable of mechanically releasing perineural adhesions and restoring nerve mobility. Alpha-2 macroglobulin (A2M), an autologous plasma protease inhibitor with anti-inflammatory and cytokine-binding properties, has recently been explored as a biologic adjunct in musculoskeletal conditions. Case Presentation: We report the case of a 60-year-old right-handed woman who presented with a one-year history of numbness, paresthesia, and pain within the median nerve distribution of her dominant hand. Ultrasound examination demonstrated a bifid median nerve accompanied by a persistent median artery and perineural edema within the proximal carpal tunnel. The patient underwent three weekly sessions of ultrasound-guided hydrodissection using autologous A2M prepared through the APEX filtration system. The patient reported progressive clinical improvement following treatment. Grip strength increased from 12 kg at baseline to 22 kg at week twelve. Follow-up ultrasound performed ten months after treatment showed restoration of median nerve fascicular architecture and normalization of nerve morphology, findings consistent with interval structural improvement. Discussion: This case highlights the role of ultrasound in the integrated evaluation and management of CTS with anatomical variants, including diagnosis, procedural guidance, and longitudinal assessment. Conclusions: Ultrasound-guided hydrodissection with A2M may represent a feasible minimally invasive approach in selected patients; however, further prospective studies are required to determine its safety and therapeutic efficacy.

Upper extremity deep venous thrombosis (UEDVT) is an uncommon clinical entity in adolescents, most often linked to central venous catheters or hypercoagulable states. Trauma-induced UEDVT is rare and challenging to diagnose due to nonspecific clinical signs that can mimic infection or soft tissue injury. We report an 18-year-old female who developed post-traumatic swelling and tenderness of the right forearm after being beaten by her school teacher. Initial non-contrast CT revealed subcutaneous edema without fracture. Subsequent CT angiography identified right brachial vein thrombosis with prominent collateral veins, confirming venous outflow obstruction. Early diagnosis allowed timely initiation of anticoagulation therapy, preventing complications. This case emphasizes CT angiography's diagnostic value in evaluating post-assault upper limb vascular injuries.