Tenosynovitis of hand: Causes and complications

Tenosynovitis represents a common clinical condition characterized by inflam-mation of the synovium that encases the tendon sheath.Although tenosynovities may be noted in any tendon in the body,extremities such as hand,and foot remain the sites of high predilection to acquire this condition.The predominant cause of this predilection rests in the intricate tendon arrangements in these extremities that permit fine motor actions.This editorial explores the common causes and the complications associated with this condition to improve the understanding of the readers of this common condition encountered in our everyday clinical practice.

Anatomic location of the first dorsal extensor compartment for surgical De-Quervain’s tenosynovitis release:A cadaveric study

BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.

Gouty tenosynovitis with compartment syndrome in the hand: A case report

BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.

Clinical Observation of Self-made Four-step Tendon Regulating Manipulation in the Treatment of 30 Cases of Thumb Stenotic Tenosynovitis

[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic tenosynovitis of thumb were treated with four-step tendon manipulation and traditional manipulation respectively, 3 times a week, a total of two weeks. The clinical efficacy, changes of visual analogue scale (VAS) and the recurrence rate after 15 d of follow-up treatment were observed before and after treatment. The differences were statistically significant ( P <0.05). [Results] After treatment, the VAS and the recurrence rate after 15 d of treatment in the observation group were significantly lower than those in the control group ( P <0.05). After treatment, the total effective rate was 73.33% in the control group and 93.33% in the observation group ( P <0.05). [Conclusions] The effect of four-step tendon regulating manipulation in the treatment of thumb stenotic tenosynovitis is ideal. The effect is significantly better than that of traditional Chinese medicine in improving thumb pain and function, which is worthy of clinical promotion.

Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature

BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery,and there are still many uncertainties regarding its diagnosis and treatment.CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature.A total of 43 articles and 61 cases were included in the literature review.Our case had a usual presentation:it was similar to those in the literature.The affected population was mainly older adults,with an average age of 59.43(range,3 to 90)years.The male-to-female ratio was 1.54:1(37/24).Most of them showed limited swelling and pain,only 23.0%had carpal tunnel symptoms,and the average disease duration was 18.03(0.5-60)mo.Wrist flexor tendon sheath involvement was the most common(95.1%,58/61),and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis(34.4%,21/61),nontuberculous mycobacteria(24.6%,15/61),idiopathic tenosynovitis(31.1%,19/61),and others(9.84%,6/61).There were 10 patients with recurrences;in 6 of them,were due to non-tuberculous mycobacterial infections.CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation,and established a clinical management algorithm for wrist tenosynovitis with rice bodies,which can provide some reference for our clinical diagnosis and treatment.The symptoms of rice-body bursitis of the wrist are insidious,nonspecific,and difficult to identify.The aetiology is mainly idiopathic tenosynovitis and mycobacterial(tuberculosis or non-tuberculous)infections;the latter are difficult to treat and require long-duration systemic combination antibiotic therapies.Therefore,before a diagnosis of idiopathic tenosynovitis is made,we must exclude other causes,especially mycobacterial infections.

Snapping wrist due to bony prominence and tenosynovitis of the first extensor compartment:A case report

BACKGROUND A snapping wrist is a rare symptom that results from the sudden impingement of one anatomic structure against another,subsequently causing a sudden movement only during wrist movement.CASE SUMMARY A 30-year-old woman with a history of right wrist contusion reported right wrist snapping after overuse.The snapping became symptomatic after moving heavy objects.The pain persisted even when she received 1 mo of conservative treatment.Physical examination showed painful wrist snapping during wrist radioulnar motion and thumb abduction-adduction.Radiography demonstrated bone overgrowth over the radial styloid process.Sonography disclosed a tendon jumping over a bony prominence in the first compartment during wrist motion.Magnetic resonance imaging revealed no anomalous tendon nor tumorlike lesion.Under the wide-awake local anesthesia no tourniquet(WALANT)technique,the lesion was identified in the first extensor compartment.The patient received stepwise extensor retinaculum release,synovectomy,and bone spur removal.By 6th week,the patient was completely free of pain and unable to snap her wrist.She started working 7 wk after the surgery.One year after the surgery,the wrist snap was not recurrent.CONCLUSION Careful physical examination and dynamic sonography may confirm the diagnosis of a snapping wrist.With the WALANT technique,the lesion could be identified under direct vision,and we could take stepwise interventions according to intraoperative presentations.

An Isolated Case of Brachyphalangism of the Basal Finger Bones of the Little Finger with Symptoms of Tenosynovitis: A Case Report

Brachydactyly is a general term that refers to disproportionately short fingers and toes and forms a part of the group of limb malformations characterized by bone dysostosis. Brachydactyly usually occurs either as an isolated malformation or as a part of a complex malformation syndrome. Brachydactyly is classified as types A, B, C, D, or E;brachymetatarsus IV;Sugarman brachydactyly;or Kirner deformity. Various types of isolated brachydactyly are rare, except for types A3 and D. We describe a 15-year-old girl with isolated brachyphalangism of the basal finger bones of the little finger with symptoms of tenosynovitis. Tenosynovitis might be caused by growth deviation between the flexor digitorum superficialis and the flexor digitorum profundus. The patient responded very well to surgical treatment.

Effectiveness of shockwave therapy for stenosing tenosynovitis of radius styloid process:a meta-analysis

Objective:To systematically evaluate the clinical efficacy of extracorporeal shock wave in the treatment of stenosing tenosynovitis of radius styloid process.Methods:All randomized controlled trials of extracorporeal shock wave in the treatment of stenotic tenosynovitis of radius styloid process were retrieved by computer.Two researchers independently screened,extracted and incorporated the literature into the literature evaluation.The quality evaluation was carried out with the bias risk assessment tool provided by Cochrane Collaboration Network,and the meta-analysis was carried out with RevMan 5.3 software.Result:According to the prescribed retrieval method,there were 8 articles and 447 subjects.The results showed that the effective rate of extracorporeal shock wave was(OR=5.37,95%CI(2.85,10.12),P<0.00001)compared with other therapies,and the difference was statistically significant.Meanwhile,there were significant differences in VAS pain score and Cooney dysfunction score.Conclusion:Extracorporeal shock wave can effectively relieve the pain symptoms of stenosing tenosynovitis of the radius styloid process,improve wrist dysfunction and improve the clinical efficiency of stenosing tenosynovitis of the radius styloid process,but a large number of high-quality studies are needed to provide more sufficient evidence.

Giant Bursitis of Wrist and Multiple Tenosynovitis of Hand with Rice Body Formation: Unusual Case of an Atypical Mycobacteria Infection

We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.

Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study

AIM To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve(SBRN) and the Lateral Antebrachial Cutaneous Nerve(LABCN).METHODS Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment(FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping(CASAM) to map the course of the nerves in each individual arm. RESULTS This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.CONCLUSION CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.

Power Doppler ultrasonographic assessment of the ankle in patients with inflammatory rheumatic diseases

Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.

Acupuncture Treatment of Superficial Pain by Subcutaneous Needling

Subcutaneous needling is an old art of the 'twelve needling methods' in TCM for treating arthralgia due to cold or disorders in the superficial tissues. Some cases are effectively treated as introduced below.……

Factors associated with trigger digit following carpal tunnel release

BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome.Carpal tunnel release(CTR)surgery may be a risk factor for trigger digit development;however,the association between surgical approach to CTR and postoperative trigger digit is equivocal.AIM To investigate patient risk factors for trigger digit development following either open carpal tunnel release(OCTR)or endoscopic carpal tunnel release(ECTR).METHODS This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit.Patients were stratified according to the technique utilized for their CTR,either open or endoscopic.The development of postoperative trigger digit was evaluated at three time points:within 6 mo following CTR,between 6 mo and 12 mo following CTR,and after 12 mo following CTR.Firth’s penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit.Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit.RESULTS A total of 47 hands developed postoperative trigger digit following 967 CTR procedures(4.9%).In total,64 digits experienced postoperative triggering.The long finger was most commonly affected.There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR.Furthermore,there were no significant independent risk factors for postoperative trigger digit;however,within group analysis revealed a significant interaction effect between gender and surgical approach(P=0.008).Females were more likely to develop postoperative trigger digit than males after OCTR(OR=3.992),but were less likely to develop postoperative trigger digit than males after ECTR(OR=0.489).CONCLUSION Patient comorbidities do not influence the development of trigger digit following CTR.Markedly,gender differences for postoperative trigger digit may depend on surgical approach to CTR.

A seropositive nodular rheumatoid polyarthritis without arthritis, does it exist?

Introduction: The rheumatoid polyarthritis is the most frequent chronic polyarthritis. It affects essentially woman between 40 and 60 years old. Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. However, it is rare that they constitute the essential clinical expression of the disease. Case report: A 60-year-old woman was hospitalized for tumefaction of the dorsal face of the right hand evolved two months before. The clinical examination was found isolated subcutaneous nodules. The anatomopathological exam of one nodule ended in its rheumatoid origin and the MRI of a second one confirmed a tenosynovitis. Anti-CCP antibodies were positive. The patient has never suffered from arthralgias. The evolution was favourable under corticosteroid therapy, methotrexate and colchicine. Discussion: Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. It is rare that they constitute the essential clinical expression of the disease. Conclusion: The extra-articular appearances of the rheumatoid polyarthritis must not be underestimated especially since they can constitute—even rarely—the essential clinical expression of the disease.

Multicentric Reticulohistiocytosis (MRH): First Case Report with Tenosynovial Fluid Analysis and Tenosynovial Histology Demonstrating the Classic Histologic Findings

Multicent ricreticulohistiocytosis (MRH) is a rare systemic disease of unclear etiology characterized by destructive, deforming arthritis, nodules in the skin, mucous membrane and internal organs and can be associated with malignancy. The tenosynovial fluid and tenosynovium histologic findings have not been reported in any case reports of MRH in the literature. To our knowledge, this is the first case report of tenosynovial fluid and tenosynovium demonstrating the classic histologic findings of histiocytes with a foamy eosinophilic cytoplasm. This case also demonstrates a non-deforming arthritis.

Musculoskeletal Tuberculosis in Dermatomyositis: Association or Coincidence?

Dermatomyositis is a rare idiopathic inflammatory myopathy characterized by proximal muscle weakness associated with typical skin abnormalities and compatible electromyographic finds. Tuberculosis could determine several clinical manifestations but the classic one is the lung presentation. Among the extra pulmonary manifestations of tuberculosis, the musculoskeletal form is rare and it is usually a direct extension of the bone involvement nearby. In the present study, the authors described two dermatomyositis patients and musculoskeletal tuberculosis. In both cases, there was presence of bilateral tenosynovitis, which is considered atypical for further infectious.

Evaluation of hand infections in the emergency department using point-of-care ultrasound

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient management.METHODS:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December 2021.Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand.We then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final disposition.RESULTS:We included a total of 50 cases(28 male,22 female)in the final analysis.The most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 times.CONCLUSION:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

小儿拇指狭窄性腱鞘炎案

A female patient,13 months old,suffering from limited extension of the right thumb for 7 days,diagnosed as stenosing tenosynovitis of the thumb in children.Tuina(Chinese massage) therapy was adopted,in which,stimulation was applied with fingers instead of needles,including pressing and kneading,twisting and kneading,plucking,dorsal extending,rotating as well as pushing and rubbing manipulations.The whole procedure of manipulation lasted around 15 min,once every two days,3 times weekly.Meanwhile,the parents were advised to bath the child patient's right hand into warm water every day and fix the affected thumb with splint at night.After 12 treatments with tuina therapy,the flexion and extension function of the affected thumb were returned to normal and the thumb motor function was recovered.In 2 months of follow-up,the thumb motor function was normal and the stenosing tenosynovitis was not recurred.In this case,tuina therapy is adopted in treatment of stenosing tenosynovitis of the thumb in children.As an alternative method of surgery,tuina therapy has a satisfactory clinical effect.

脐针治疗桡骨茎突狭窄性腱鞘炎案

The gen and mao areas,and the responding area of hand were punctured in umbilicus acupuncture,reperfusion activities were also done for a stenosing tenosynovitis of styloid process of radius patient in lactation period,sound effect were obtained.