Sarcoidosis of the upper extremity: case presentation and literature review.

Sarcoidosis of the skeletal system is not rare but problems related to it are unusual. Two cases of sarcoidosis, with involvement of the upper extremity, are presented to point out problems that may occur in its treatment. Osteolytic sarcoid involvement of the phalanges leads to resorption and collapse, with a poor response to bone grafting or splinting. The phalangeal collapse could be treated with intramedullary cement or Kirschner wire fixation. Sarcoid involvement of fractures can lead to a nonunion and they should be treated with excision when appropriate, rather than attempting osteosynthesis. Arteriograms of sarcoid lesions show them to have a very poor blood supply. A bone scan can be used to demonstrate areas of sarcoid involvement before the characteristic lesion becomes evident on a radiography.