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Seven cases of chronic tenosynovitis affecting the extensor carpi radialis or lateral digital extensor tendon and their sheaths are described. All cases were chronic and in 4 of the cases previous treatment by drainage and local corticosteroid injection had been ineffective. Surgical exploration of 6 cases demonstrated a distinct lesion and specific surgical treatment was carried out.
Contrast radiography, using a 25 per cent solution of sodium diatrizoate, has been used for the investigation of tenosynovitis and bursitis in horses. The procedure was undertaken on a series of 32 clinical cases and on specimens obtained at autopsy. Lesions affecting the extensor tendon sheaths at the carpus, the digital sheath, the tarsal sheath and the bursae at the elbow, hock and fetlock were examined by this means. The results showed the procedure offered the clinician useful information about the nature of the interior of these structures, particularly as regards the presence of adhesions and anastomoses between adjacent sheaths and joint capsules. Together with other clinical and laboratory findings, contrast radiography can assist in assessing the prognosis and in formulating appropriate treatment.
The history, clinical features, radiological findings, treatment and outcome of 15 horses with chronic tenosynovitis of the carpal extensor tendon sheaths are reported. The condition was seen most commonly in horses used for jumping and penetration of the tendon sheaths by thorns was the most common aetiology. Treatment involved surgical resection of the hyperplastic synovial membrane, and adhesions within the tendon sheath, with primary closure. When combined with early postoperative physiotherapy this was found to be an effective method of treatment. All horses in this series were not lame at follow-up, with 14 horse returning to their former level of athletic performance.
A case of severe progressive subcutaneous abscesses and necrotizing tenosynovitis of the right arm of a 30-year-old woman caused by Rhodococcus aurantiacus is reported.
BACKGROUND: Patients with heterozygous familial hypercholesterolaemia (HeFH) develop tendon xanthomata (TX), most commonly in their Achilles tendons. Even before tendons are chronically enlarged, tenosynovitis may occur and medical advice be sought. Untreated HeFH carries a high risk of premature coronary heart disease, which can be ameliorated by early diagnosis. OBJECTIVE: To determine the prevalence of episodes of Achilles tendon pain in HeFH before its diagnosis. METHODS: Patients with definite HeFH (Simon Broome criteria) attending a lipid clinic were identified. They completed a questionnaire asking about symptoms relating to their Achilles tendons. Unaffected spouses or cohabiting partners served as controls. RESULTS: 133 patients (47% men) and 87 controls (51% men) participated. TX had been recognised by the referring physicians in <5% of cases. However, 62 (46.6% (95% confidence interval (CI) 38.1 to 55.1)) patients had experienced one or more episodes of pain in one or both Achilles tendons lasting >3 days, whereas only 6 (6.9% (1.6 to 12.2)) controls had done so (difference p<0.001; likelihood ratio 6.75). Typically, in the patients with HeFH the pain lasted 4 days (median). It was described as severe or very severe in 24/62 (38.7% (30.4 to 47.0)) patients with HeFH, but never more than moderate in controls. 35 (26.3% (18.8 to 33.8)) patients with HeFH had consulted a doctor about Achilles tendon pain, but in no case had this led to a diagnosis of HeFH. None of the controls had consulted a doctor. CONCLUSIONS: Measurement of serum cholesterol in patients presenting with painful Achilles tendon could lead to early diagnosis of HeFH.
Mammalian bites present a considerable clinical problem because they are often associated with bacterial infections. Pasteurella multocida is a microorganism that commonly infects both canine and small feline bites. Zoonotic infections developing after large feline bites have been recognised, although their reports are limited. We describe a 35 year old man who was bitten by a Siberian tiger and who developed infectious tenosynovitis secondary to P multocida, Bergeyella (Weeksella) zoohelcum, and Gram negative bacteria most like CDC group EF-4b and comamonas species. The latter three bacteria have not been isolated previously from large feline bite wounds.
Chronic septic tenosynovitis with concurrent, associated focal osteomyelitis of the lateral proximal sesamoid bone was diagnosed in a seven-year-old thoroughbred gelding. Surgical management of this case consisted of open annular ligament desmotomy and curettage of the affected sesamoid. Following lavage of the digital sheath the incisional wound was closed but a 2 cm gap was left distally to allow for postoperative open drainage. The distal limb was bandaged and the horse treated with antibiotics and non-steroidal anti-inflammatories. Sepsis resolved and the horse made a gradual return to full work.
A modified open annular ligament desmotomy followed by passive open drainage was used to treat 12 horses with chronic digital septic tenosynovitis due to trauma in the form of open wounds or self-sealing punctures. The surgical approach included complete transection of the palmar/plantar annular ligament of the fetlock and proximal digital annular ligament, which facilitated the removal of fibrin, selective debridement and synovectomy, followed by lavage of the digital sheath. The incision was partially closed leaving a 2 cm gap open distally to allow for passive open drainage. Gentamicin was administered intrathecally during surgery. Postoperatively the horses received ceftiofur and non-steroidal anti-inflammatory drugs. A sterile bandage was used to protect the wound until the gap had healed completely by second intention. Infection was controlled in 11 of the horses which all returned to their previous levels of work, but one horse was euthanased as a result of the persistence of the infection and financial considerations.
A 52-year-old woman with systemic lupus erythematosus (SLE) was infected with tuberculosis (TB) on her forearm and hand, after 16 years of steroid therapy. Debridements and anti-TB therapy were performed successfully. Recently, the risk of significant morbidity from TB has been on the rise; this appears to be a complication of steroid therapy used to treat AIDS and some collagen vascular diseases. It is thought that steroid therapy causes an increased risk of TB. In this paper, we report our experience of this SLE patient who developed tuberculous tenosynovitis. We suggest that TB infection must be considered in the differential diagnosis whenever a patient presents with a chronic wrist or hand inflammation that is non-responsive to steroid treatment. Once TB infection is suspected, both histopathological and bacteriological examinations should be performed. Emergent treatment includes surgical debridement and the institution of early anti-TB therapy immediately after completing histopathological examination.
Hemangioma of the tendon sheath is rarely reported. In this case report, a 22-year-old man, who had been seen for peroneal tenosynovitis before (although symptoms remained) was reevaluated. A cavernous hemangioma was located in the peroneal muscle and the tendon. Complete excision was performed.
Twelve cases of stenosing tenosynovitis about the ankle (eight posterior tibial and four peroneal), with at least 2 to 4 years of follow-up, have been successfully relieved of their symptoms and returned to increased activity by utilizing a simplified comprehensive surgical technique. Surgery consists of: 1) appropriate treatment to the tendon itself whether intact, partially ruptured, or completely ruptured; 2) deepening of the constricted groove; 3) fashioning of new pulleys from available sheath and retinaculum; and 4) construction of a new sheath from regional deep fascia. Postoperative management includes non-weightbearing, soft bandages, and home exercise therapy for 1 month, followed thereafter by intensive home therapy buildup of the involved muscle and orthoses. Pathology findings included thickening of the tendon sheath, varying degrees of fibrosis of the tendon itself, with or without rupture, and reactive hypertrophy of the bone at the involved groove.
The purpose of this paper is to call attention to the previously overlooked entity, stenosing tenosynovitis of the flexor hallucis longus tendon in the sesamoid area of the great toe. Nine patients have been tabulated and successfully treated during the past 4 years, with an average 2 1/2-year follow-up. Trauma seems to be the causative factor. Five cases had accompanying pathology. Three cases responded to inflation of the tendon sheath with 1% lidocaine anesthesia, but the remainder required tenolysis of the sheath plus surgery to the accompanying pathology for relief. Early recognition of this problem and prompt inflation with lidocaine may be the only required treatment if this is the only entity. Chronic cases will respond to tenolysis. A plantar full visualization surgical approach is recommended.
A 61-year-old woman presented with mild pain and swelling on the volar aspect of the wrist, hand, and little finger. Radiography showed a soft-tissue mass shadow, and magnetic resonance imaging showed acute tenosynovitis of the flexor tendons and an inflammatory mass inside the carpal tunnel. Laboratory test results were normal, except for an elevated erythrocyte sedimentation rate (40 mm/h). The patient had an ambiguous Mantoux test result but no history of mycobacterial exposure. Exhaustive investigations for rheumatic disease were negative. Surgical exploration of the lesion revealed rice bodies in the common flexor tendon synovial sheath, extending distally to the tip of the fifth finger. Removal of the rice bodies and thorough excision of the sheath was performed. The patient regained a full and painless range of motion in about 3 months. One-year follow-up revealed no underlying disorder.
Traumatic tenosynovitis of the wrist extensors is a common and disabling condition associated with overuse. It has been found to be associated with hypertrophy of the bellies of abductor pollicis longus and extensor pollicis brevis where they overlie the radial extensor tendons in the forearm, compressing these tendons and their enveloping paratenons against the deep structures beneath. Simple surgical decompression of the sheath of these overlying muscles has been found to give quick relief of symptoms and to allow a more rapid return to strenuous work than the conservative treatments usually employed.
Chronic non-specific tenosynovitis of the posterior tibial tendon is a well-known clinical entity, characterised by pain, swelling and tenderness behind the medial malleolus. There are no reports in the literature of any case associated with any radiological abnormality. Three such cases are discussed, each presenting with the clinical findings typical of the syndrome but with associated radiological changes. These changes may pose diagnostic problems and several primary conditions need to be excluded. Surgical decompression of the tendon may be necessary to relieve symptoms, to prevent erosion and rupture of the tendon, and to establish the diagnosis.
Diabetes mellitus (DM), particularly of long duration and insulin dependent, can be accompanied by a variety of locomotor system disorders. However, musculo-skeletal syndromes can also appear in patients with mild glucose homeostasis disturbances. Sometimes these locomotor complaints may precede the diagnosis of the deranged glucose metabolism and hence give a clue to the underlying glucose homeostasis abnormality. In the present work, glucose metabolism was studied in 39 patients presenting with palmar flexor tenosynovitis (FTS) but without any other rheumatic manifestations. For comparison, glucose homeostasis was also studied in 44 patients with FTS accompanying rheumatoid arthritis (RA). In the first group, 23% had an abnormal oral glucose tolerance test (OGTT), a significantly increased frequency vis-à-vis the 4.5% found in the RA group and vis-à-vis the 5.4% reported for the general population. It is concluded that in the absence of any other rheumatic disease, FTS is a risk indicator of disturbed glucose metabolism and that a simple screening procedure for the purpose of disclosing glucose homeostasis abnormalities is warranted in patients presenting with FTS.
Experiments were conducted to determine the efficacy of simultaneous administration at 1 day of age of the herpes virus of turkeys vaccine (HVT) and viral tenosynovitis (VT) vaccine. Day-old broilers from commercial breeders, which were immunized against both MD and VT, were used. The vaccines were injected at full dosage or diluted 1 to 4. Challenge with either Marek's disease virus (MDV; intraperitoneal) or VT virus (footpad) was at 7 days of age. At 7 wk of age, birds were weighed, killed, and examined for gross lesions. Either vaccine given at full dosage alone, or in combination, rendered birds resistant to homologous viral challenge. However, when either vaccine was diluted and administered alone, the efficacy of the VT but not the HVT vaccine was reduced, resulting in increased lesions and mortality and decreased weight gain after VT challenge. When the HVT vaccine was diluted and combined with undiluted VT vaccine, interference occurred, resulting in reduced efficacy of the HVT vaccine (increased tumors and mortality and reduced body weight). In contrast, combining the HVT at full dosage and the diluted VT vaccine given alone. The data indicate that caution should be maintained when mixing HVT and VT vaccines. For maximum efficacy, both vaccines should be mixed undiluted when administered simultaneously.
Five dogs of varying breeds, ranging from 4 to 8 years in age, were presented with clinical signs consistent with bicipital tenosynovitis. After failure of conservative treatment, each dog underwent shoulder arthroscopy. Following examination of the scapular humeral joint, the bicipital tendon was severed with a bipolar radiofrequency electrosurgical system. The arthroscopic procedure resulted in a good to excellent outcome for all five dogs.