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PubMed2003

Gouty flexor tenosynovitis of the digits: report of three cases.

Gouty tenosynovitis in the hand is a rare entity. To date the limited cases described have involved predominantly extensor tendons in the fingers and flexor tendons in the palm or wrist. Flexor tendon involvement is less common and has been reported only twice to our knowledge distal to the palm. We report 3 cases of extra-articular gout presenting as tophaceous involvement of flexor tendons in the fingers. All cases were treated surgically. These cases are presented to heighten awareness of this rare entity and to provide a setting for a discussion of management.

Aged↗
PubMed1978

Closed tendon sheath irrigation for pyogenic flexor tenosynovitis.

Twenty patients with pyogenic flexor tenosynovitis were treated by through-and-through saline irrigation using an indwelling catheter and small Penrose drain. The treatment lasted for 48 hours. All patients were discharged from the hospital within 4 days. Eighteen patients had regained complete active and passive motion by 1 week after operation. One patient had a slight residual flexor tendon adherence and one gained motion after operation. This technique provides rapid, complete return of function with minimal inconvenience to the patient.

Adolescent↗
PubMed1981

Reduction flexor tenoplasty. Treatment of stenosing flexor tenosynovitis distal to the first pulley.

Trigger finger due to stenosing flexor tenosynovitis distal to the first annular pulley is not a common finding; however, when present, it introduces a diagnostic and therapeutic challenge. Resection of the second annular pulley for release of triggering at this level may leave the patient with impaired function. The pulley can be preserved by removing an elliptical portion of the center of the tendon through a lateral incision.

Adult↗
PubMed1983

Flexor tenosynovitis caused by Coccidioides immitis.

Coccidioidomycosis is a rare disease and dissemination of the pulmonary infection occurs in less than 0.1% of cases. A case report of coccidioidal tenosynovitis in association with immunosuppressive chemotherapy is described. Recommended management includes both intravenous amphotericin B and surgical synovectomy.

Coccidioidomycosis↗
PubMed1985

Gouty tenosynovitis in the hand.

Gouty tenosynovitis can present as an infection, tendon rupture, nerve compression, or digital stiffness. In ten patients, extensive urate deposition was encountered in the extensor tendons at both the wrist and digital levels in addition to involvement of the flexor tendons in the carpal canal and digital theca. Direct nerve or muscle involvement was not observed in the hand. Medical therapy, which is now the cornerstone of treatment for most aspects of gout, may not be the best treatment for tophaceous deposits in the hand. Operative treatment may be required to debulk tophaceous deposits, improve tendon gliding, decompress nerves, allow increased range of motion of joints, and ameliorate pain.

Adult↗
PubMed1985

Mycobacterium terrae tenosynovitis.

A 72-year-old man was admitted with tenosynovitis of the left forearm and hand. Histopathologic examination of the excised tissue showed noncaseating granulomas. Mycobacterial culture produced Mycobacterium terrae complex. M. terrae infection of any site is rare. Analysis of four documented cases and our present case indicates that this organism causes infection in the forearm and hand after probable direct inoculation. It has not disseminated systemically from the site of local infection and may infect otherwise healthy hosts.

Aged↗
PubMed1986

Sterile flexor tenosynovitis of the hand: a report of three cases.

Three patients presented with classic signs and symptoms of acute bacterial tenosynovitis. In each instance, the inflammatory condition was found to be sterile. The patients had no other known systemic diseases associated with sterile inflammation. Two patients had digital sheath exploration. The third patient had diagnostic digital sheath aspiration. Hand elevation, rest, and prophylactic antibiotics resulted in complete resolution in all three patients. One digital sheath biopsy specimen submitted for electron microscopy showed no evidence of a viral etiology.

Adult↗
PubMed1986

Sporothrix schenckii tenosynovitis: a case report.

Sporothrix schenckii is a fungus known to cause infection of skin in the subcutaneous tissues. In this case tenosynovitis was caused by sporotrichosis resulting in rupture of the extensor tendon. Excision of the involved tenosynovium and repair of the tendons were done. Five months of oral medication with ketoconazole, 400 mg daily, led to resolution of the synovial disease and regression of a 1 cm pulmonary nodule found on a routine chest x ray film.

Aged↗
PubMed1986

Sarcoid flexor tenosynovitis of the finger: a case report.

A case report of flexor tenosynovitis of the right ring finger in a 27-year-old black woman leading to the diagnosis of sarcoidosis is presented. Sarcoidosis of a flexor tendon sheath is rare. Flexor tenosynovectomy provided material for histologic diagnosis and increased the function of the hand.

Adult↗
PubMed1986

Stenosing tenosynovitis of the extensor carpi ulnaris.

Stenosing tenosynovitis of the extensor carpi ulnaris, to our knowledge, has not been previously reported. This condition, although uncommon, should be considered in the differential diagnosis of pain over the dorsoulnar aspect of the wrist. We report three cases with good response to surgical decompression of the sixth dorsal compartment of the wrist.

Adult↗
PubMed1988

Symptomatic restrictive thumb-index flexor tenosynovitis: incidence of musculotendinous anomalies and results of treatment.

During a 5-year period, 33 patients with pain in the palmar aspect of the wrist and forearm with and without features of carpal tunnel syndrome were diagnosed as having restrictive thumb-index flexor tenosynovitis. The pathognomonic sign in this condition was the simultaneous flexion of the index finger with active flexion of the thumb across the palm. Treatment included either steroid injection into the tendon sheath of the flexor pollicis longus or surgical exploration of the palmar aspect of the distal forearm and wrist region. Twenty-six wrists in 24 patients were surgically explored, and all had hypertrophic tenosynovium between the flexor pollicis longus and index profundus tendons. More than half of the explored wrists had a tendinous connection between the flexor pollicis longus and the flexor profundus of the index digit. Of 17 wrists with follow-up of more than 6 months, 13 were improved by surgical management. Steroid injection did not have a long-term effect.

Adolescent↗
PubMed1996

Flexor tenosynovitis caused by Mycobacterium bovis: a case report.

A case of flexor tenosynovitis caused by Mycobacterium bovis is presented. Since the incidence of Mycobacterium bovis infections are very rare in humans, clinical suspicion is important for diagnosis. The treatment is a combination of chemotherapy and surgical debridement.

Adult↗
PubMed1997

Flexor tenosynovitis in the hand caused by Mycobacterium malmoense: a case report.

This report analyzes a rare case of flexor tenosynovitis caused by Mycobacterium malmoense. A synovectomy was carried out on the index finger (no other finger was afflicted) of a 66-year-old farmer, followed by antibiotic therapy with ethambutol, rifampin, and clarithromycin. Because of strong side effects, the treatment with ethambutol and rifampicin had to be discontinued after 4 months. There was no recurrence after 14 months, and the patient's finger had a full range of motion.

Aged↗
PubMed1998

Flexor tenosynovitis due to Mycobacterium asiaticum.

Mycobacteria other than tuberculosis infections of the hand are seen with increasing frequency. A case of Mycobacterium asiaticum flexor tenosynovitis is described. Successful management included radical flexor tenosynovectomy and therapy with oral minocycline and clarithromycin.

Adult↗
PubMed1995

Infectious tenosynovitis.

Infectious tenosynovitis is treated similarly to infectious arthritis. The principles of treatment include an early diagnosis and immediate therapy. Therapy should include use of systemic and local antimicrobials and sheath lavage and drainage. Fibrosis and adhesions can be minimized with passive range of motion exercises, intrathecal hyaluronate, and phenylbutazone therapy. Restrictive fibrosis may be treated successfully by annular ligament resection.

Animals↗
PubMed1993

[Mycobacterium terrae tenosynovitis of the hand].

This article presents the seventh case of human infection due to Mycobacterium terrae. This report of typical tenosynovitis clearly illustrates well all of the standard problems raised by this kind of atypical acid-fast mycobacterial infection: delayed and difficult diagnosis, danger of steroid infiltrations, frequency of recurrence. Nevertheless, M. terrae has certain specific features: it is probably less pathogenic than other atypical acid-fast such as marinum. Some authors propose surgical treatment alone, but this case suggests the need for surgery combined with antituberculous therapy.

Adult↗