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Involvement of the soft tissues of the hand by sarcoidosis is rare. We report a patient with sarcoidosis who presented with a large subcutaneous plaque of the palm and flexor tenosynovitis of the middle finger.
Over a 12-year period (1979-1991), 130 carpal tunnel syndromes were diagnosed in 89 haemodialysed renal failure patients, representing 17% of all haemodialysed patients followed over the same period. 6% of patients had been haemodialysed for less than 5 years (mean duration of dialysis: 10.4 years). 25% of cases had a trigger finger and 21 out of 89 patients had amyloid arthropathy. No precise relationship was detected between the side of the carpal tunnel syndrome and the side of the arteriovenous fistula. In 130 cases, release of the median nerve and wide tenosynovectomy of the flexor tendons were performed under pneumatic tourniquet except in the case of a prosthetic shunt. Tenosynovial amyloid deposits were found in 84% of cases. The mean postoperative follow-up was 40 months (range: 6 to 120 months). Postoperatively, the acroparaesthesiae disappeared in 93% of cases. 79% of cases with a sensory defect obtained sensory recovery, versus 27% of cases with a motor deficit for motor recovery. In 20% of the 130 cases, decreased digital mobility was observed postoperatively due to extension of the tenosynovitis to the fingers. Four cases of recurrence were observed.
De Quervain disease (1895), tenosynovitis of Abductor Pollicis Longus and Extensor Pollicis Brevis, passing through their tunnel above the Radial Styloid Process, is not always cured by medical treatment but often requires surgical treatment. So, it is necessary to use a surgical one. The classical procedure, simple section of the radio-styloid pulley, is often complicated by the shifting of the two tendons on the radial styloid process caused by the wrist movements. Recently, an Italian author, G. Codega proposed an enlarging-reconstructing technique. The one described in this article consists of enlargement of the pulley by means of a diagonal incision, followed by suture after shifting of the diagonals. This technique ensures a real enlargement and solid reconstruction which allows early rehabilitation. The pain disappears at the same time as post-operative pain. Because of the small number of patients operated to data, it is not yet possible to perform statistical analysis, but the results have always been good or excellent.
Tuberculosis of tendon sheaths of the hand was rare before the advent of antituberculous drugs. It seems now-a-days exceptional, for the published series become more an more uncommon and smaller. Therefore, the diagnosis is often an operative surprise on a patient with a painless, gradually developing tenosynovitis. No patient suffered from other active tuberculosis. But two of them had an old history of tuberculosis (knee and kidney). Analysis of other cases is inconclusive about the relation ship between trauma and tuberculosis. Histology and cultures establish the diagnosis. Surgical treatment consists in large excision of involved tissues. The damages provoked by the illness are often important, with sometimes tendon ruptures. However, functional results are surprisingly not so bad. Antituberculous drugs are the backbone of the surgical treatment for several months.
This report describes a case of congenital synostosis between the scaphoid and the trapezium resulting in tenosynovitis simulating de Quervain's disease, an association not previously reported.
This short paper demonstrates that the Finkelstein's test in De Quervain's tenosynovitis is based on an incorrect assumption. The correct basis for a pathognomic manoeuvre in De Quervain is the provocation of tendons attrition of the first wrist dorsal compartment against their pulley which elicits pain. The Brunelli's test induces this friction and pain by asking the patient to hardly adduct the thumb with the wrist in radial deviation.
A case of cavernous haemangioma arising from the superficial palmar arch is described. The initial symptoms were those of a subacute tenosynovitis. Surgical exploration showed that the tumor was not affecting the flexor tendons. It was completely resected and the patient had full recovery of hand function.
A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.
Tibialis anterior tenosynovitis is a rare orthopaedic condition that usually resolves with conservative treatment. Surgery may be required for chronic cases and endoscopy seems to be a valid therapeutic alternative. During debridement of the hypertrophic synovium, care must be taken to avoid damaging the extensor retinaculum to prevent potential postoperative bowstring phenomenon of the tendon.
We present a case in which Mycobacterium kansasii flexor tenosynovitis caused the development of carpal tunnel syndrome. The diagnosis was made from synovial tissue specimens taken at the time of operation.
The records of 75 patients admitted with pyogenic flexor tenosynovitis at two academic centers were reviewed. The functional outcomes of patients who received intraoperative irrigation only (n = 20) and those that had both intraoperative irrigation and continuous postoperative irrigation (n = 55) were compared. There were no statistically significant differences between the outcomes in the two groups.
We describe the first case of tenosynovitis due to Mycobacterium heckeshornense, a mycobacterium characterized in 2000 and only incriminated in a few previous cases of infections. Molecular identification of this pathogen included 16S rRNA and hsp65 gene sequencing. M. heckeshornense may cause a wide spectrum of human infectious diseases and may be underestimated due to its phenotypic relatedness with Mycobacterium xenopi.
The clinical characteristics, outcome and treatment of non-tuberculous mycobacterial tenosynovitis are reviewed. From lesions localized in the hand, 10 different species of non-tuberculous mycobacteria have been reported. The most common are Mycobacterium marinum and Mycobacterium kansasii. Other less frequent organisms are Mycobacterium avium complex, Mycobacterium szulgai, Mycobacterium terrae, Mycobacterium fortuitum, Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium malmoense and Mycobacterium xenopi. The infections appear to be the result of previous trauma, surgical procedure, corticosteroid injection or non-apparent inoculation (water contamination). Immunosuppression is sometimes associated with the infections and can be considered as a risk factor. Surgical debridement and appropriate mycobacterial cultures are critical to enable diagnosis and appropriate management. Specimens should be inoculated on a range of media and incubated at a range of temperatures in order to isolate mycobacteria with different growth characteristics (with prolonged incubation). The optimal treatment of these infections is discussed.
We describe a new surgical technique for the treatment of de Quervain tenosynovitis, which consists of lengthening the first dorsal compartment without disruption of continuity and without using a suture. Our results in 12 wrists operated on in 10 patients indicated complete relief of symptoms. The advantages of the technique include: simplicity, restoration of normal anatomy, and prevention of complications (scarring, adhesions, and subluxation of tendons).
Six cases of chronic tenosynovitis of the hand due to the Mycobacterium terrae complex were identified. All isolates from the six cases were identified as Mycobacterium nonchromogenicum by high-performance liquid chromatography and by testing for susceptibility to ofloxacin and to 5% NaCl. Ethambutol, sulfonamides (or trimethoprim-sulfamethoxazole), erythromycin, and streptomycin are the drugs most active against isolates of the M. terrae complex, and therapy with some combination of these agents plus surgical debridement offers the best current treatment of this disease. This study supports the contention arising from previous case reports of pulmonary disease that M. nonchromogenicum is the pathogenic member of the M. terrae complex.
In immunocompetent patients, Mycobacterium avium/Mycobacterium intracellulare complex (MAC) has been associated with pulmonary infection in adults, cervical lymphadenitis in children, and disseminated infection in children and adults. MAC rarely has been recognized as a cause of localized soft-tissue infection in immunocompetent hosts. Six cases of granulomatous tenosynovitis due to MAC are reported; five cases occurred after local surgical procedures, trauma, or corticosteroid injection. In four cases, cure was achieved with combined medical and surgical intervention. In these six cases and 11 previously reported cases, both males and females were affected equally, usually in the fifth to seventh decades of life, and the distal upper extremity was predominantly involved. Surgical debridement with appropriate culture was critical for diagnosis and management. Antimycobacterial chemotherapy seemed to be a beneficial adjunctive measure in most cases but was clearly necessary for cure in only a few cases.
This case report describes a 41-year-old female patient who had chronic de Quervain's tenosynovitis, which had progressed to include involvement of the cervical spine, shoulder girdle, and upper extremity. The patient complained of aching over the left scapula, a band of pain around the upper arm, and sharp shooting pain in the forearm, with numbness and tingling in the fingers. On examination, she had abnormal palpatory findings in the cervical spine, the shoulder quadrant maneuver was limited, and the upper-limb tension tests (neural structures) were positive. The case report demonstrates the use of an Australian approach to manual therapy as described by Maitland. This approach includes (1) development, refinement, and rejection of working hypotheses as to the possible cause(s) of a patient's symptoms; (2) development of a long-range treatment plan; and (3) use of data from treatment responses to guide further treatment selection.
Assessment of the effect of therapy-physical, surgical, or local corticosteroid injections-in the management of rheumatoid flexor tenosynotivitis has proved difficult. This paper describes a simple, accurate and reproducible method of documentation using a photocopying technique. Its application to a study of the role of hydrocortisone injections in the management of flexor tenosynovitis is presented.