| 제목 |
Idiopathic hypertrophy of the first dorsal interosseous presenting as a mass: A Case Report |
| 소속 |
Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Department of Rehabilitation Medicine 1 |
| 저자 |
Kun-Woo Kim1*, Jin-Tae Hwang1, Jae-Hyung Choi1, Jong-Geol Do1, Kyung Jae Yoon1, Yong-Taek Lee1† |
Anomalous muscle conditions in the hand can be categorized into three types: hypertrophy, accessory muscle, and abnormal distal extension of proximal muscle. Among them, accessory abductor digiti minimi is the most common and its prevalence has been reported up to 24%. However, idiopathic hypertrophy of the first dorsal interosseous is extremely rare. It was first described in 1988 and only few cases have been published since then. To our knowledge, in Korea, there is no reported case of this condition. Here, we report the first case of an idiopathic first dorsal interosseous hypertrophy in Korea, presented as a mass lesion of non-dominant hand and diagnosed by ultrasonography and magnetic resonance imaging.
A 36 year-old man presented with a mass in his left hand at the first web space. The man reported that he had noticed the mass 3 weeks ago, but the exact onset was uncertain. He had no pain or any other symptoms, such as functional restriction of hand. The patient was right handed and worked as an office worker. There was no reported history of trauma or other activities that would predispose the patient's hand to be swollen. On inspection, there was a mass-like lesion at the dorsal aspect of the first web space (Figure 1). The mass was soft on palpation, and there was no tenderness, heating sensation or redness at the site. Muscle strength, sensation and range of motion of hand were normal. Plain radiography showed no bony abnormality. Ultrasonography (US) on the dorsal aspect of first web space revealed a hypertrophy of the first dorsal interosseous in left hand. The US image of the muscle showed normal muscular echotexture with hyperechoic fibroadipose septa separating the hypoechoic muscle bundles. The maximal thicknesses of left and right first dorsal interosseous on the long axis view were 10.5 mm and 7.7 mm, respectively (Figure 2). To rule out pathologic conditions such as soft tissue tumor, magnetic resonance imaging (MRI) were conducted. MRI demonstrated hypertrophy of the left first dorsal interosseous muscle with normal signal intensity. In the contrast enhanced T1-weighted images, abnomally enhanced lesion was not observed (Figure 3). |
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Figure 1. Picture of the patient’s both hand. Mass-like lesion of the left first dorsal web space is shown.
Figure 2. Ultrasonography of (A) left and (B) right first dorsal interosseous in the long axis view. The maximal thicknesses of left and right first dorsal interosseous were 10.5 mm and 7.7 mm, respectively. Asterisk, first metacarpal bone; FDI, first dorsal interosseous.
Figure 3. Magnetic resonance imaging of left hand : (A) Coronal view of proton density-weighted image, Axial view of (B) T1-weighted image and (C) contrast enhanced, fat suppressed, T1-weighted image. Hypertrophied left first dorsal interosseous muscle with normal signal intensity is shown.
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