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PubMed1995

Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus.

A comparative prospective study of 120 adult diabetics (60 insulin dependent, 60 non-insulin dependent) and 120 non-diabetic adults as controls showed significantly higher incidence of Dupuytren's disease, limited joint motion, carpal tunnel syndrome, and flexor tenosynovitis in the diabetic population. Of the diabetic patients one third had a mild non-progressive form of Dupuytren's disease, which commonly involved the long and ring rays. Limited joint motion was noted in a third of diabetics, and carpal tunnel syndrome was observed in 15-25%, and flexor tenosynovitis in about a fifth. Limited joint motion co-existed with Dupuytren's disease in 57% of insulin-dependent diabetics. Diabetic polyneuropathy was found in two thirds of insulin-dependent diabetics and in one third of non-insulin dependent diabetics. All these hand changes were more marked in insulin-dependent diabetics and they showed a positive correlation with increasing age of the patient, duration of the diabetes, and the presence of a microangiopathy.

Adult↗

PubMed1992

An analysis of the flexor synovium in idiopathic carpal tunnel syndrome: report of 625 cases.

This study was undertaken to determine the presence or absence of tenosynovitis in persons with idiopathic carpal tunnel syndrome. Eight hundred thirty-five consecutive operations for carpal tunnel syndrome were retrospectively reviewed, and 625 cases of idiopathic carpal tunnel syndrome were identified. Of these 96% (601) had a synovial tissue histologic diagnosis of benign fibrous tissue without inflammation, 4% (23) showed chronic inflammation, and 0.2% (1) revealed evidence of acute inflammation. We believe that tenosynovitis is not a part of the pathophysiologic process in chronic idiopathic carpal tunnel syndrome. Further histologic analysis of the flexor synovium for pathologic changes other than inflammation is needed.

Acute Disease↗

PubMed1991

Tendon subluxation after de Quervain's release: treatment by brachioradialis tendon flap.

Volar subluxation of the tendons of the first dorsal compartment of the wrist occurred in two patients after surgery for treatment of de Quervain's stenosing tenosynovitis. In both patients a painful tenosynovitis of the extensor pollicis brevis and abductor pollicis longus developed, which was unresponsive to conservative therapy as the tendons prolapsed over the prominence of the first dorsal compartment. A distally based flap of the brachioradialis tendon was used to prevent tendon prolapse, with both patients asymptomatic and free of subluxation one and five years after operation.

Adult↗

PubMed1978

Flexor tenosynovectomy in the rheumatoid finger.

The usual operation fo stenosing flexor tenosynovitis is resection of the proximal pulley. In the rheumatoid hand this operation may not be proper because motion still may be limited by the thickened synovium more distally, and also because there is a greater chance for the production of ulnar drift later on if the proximal pulley system is obliterated. The operation we recommend for the finger with rheumatoid tenosynovitis is a tenosynovectomy, but with maintainence of the pulley system and resection of one slip of the superficialis in order to decompress the digital theca. We have performed this operation on 54 fingers with satisfactory results.

Arthritis, Rheumatoid↗

PubMed1982

Factors related to the resolution of treated hand infections.

One hundred thirty-eight patients with acute hand infection (81% deep) treated from 1970 to 1980 in hospital were reviewed. Resolution time of infection was slow, 8 days or longer in 57% of 135 patients and 15 days or longer in 28%. Such slow resolution occurred in infection of closed anatomical spaces and included 50% of all pulp space and joint infections, 23% of tenosynovitis, and 24% of subcutaneous dorsal had infections. There was a direct correlation between increasing treatment delay and slower resolution of infections in pulp spaces, palmar spaces, joints, and tendon sheaths. If the mean treatment delay was greater than a brief 2 1/2 days, 69% of tenosynovitis showed delayed resolution. Other factors associated with the rate of resolution were adequacy of surgical drainage, efficacy of antibiotics, and associated diabetes mellitus.

Acute Disease↗

PubMed1998

Seronegative spondylarthropathies: imaging of spondylitis, enthesitis and dactylitis.

Sacroiliitis is an indispensable condition for the diagnosis of ankylosing spondylitis according to the present criteria and is usually diagnosed on standard anteroposterior radiographs of the pelvis. In cases with suspicious abnormalities (grade 1 of the New York criteria) CT permits the diagnosis since it shows a higher degree of sacroiliitis. MRI is superior to CT in the early diagnosis as it can detect the cartilage abnormalities which precede bony changes. 'Romanus lesions' with 'shiny corners', 'squaring' of the vertebral bodies, syndesmophytes, spondylodiscitis and osteoporosis are the radiological findings of ankylosing spondylitis. The nonmarginal, asymmetric, coarse and broad syndesmophytes of psoriatic spondylitis and spondylitis associated with Reiter's syndrome resemble the flowing bone outgrowths of diffuse idiopathic skeletal hyperostosis (DISH). The ossification of the posterior longitudinal ligament and of the flavum ligament are rare manifestations of ankylosing spondylitis. Peripheral extra-articular enthesitis is a clinical hallmark of seronegative spondylarthropathies. Plain film radiography shows erosions and spurs but only in advanced phases. US shows the swelling of the entheses and the peritendinous soft tissues and the distension of adjacent bursae by fluid collection. MRI shows the inflammation of the bone adjacent to the insertion as well as the soft tissue changes. Dactylitis is another typical manifestation of seronegative spondylarthropathies. In the past it was thought to be due to concomitant tenosynovitis and arthritis. Recently, however, we have demonstrated with US and MRI that the 'sausage-like' appearance is due to the flexor tenosynovitis and that joint capsule distension is not indispensable.

Bone Remodeling↗

PubMedDate not supplied

Intersection syndrome: a case report and review of the literature.

Intersection syndrome is a condition that should be differentiated from DeQuervain's stenosing tenosynovitis, as there are many subtle differences in treatment and prognosis. We present a case of intersection syndrome, describing its characteristic clinical and anatomic features, and highlighting differences in the areas of diagnosis and treatment relative to the better known DeQuervain's tenosynovitis.

Adult↗

PubMed1995

[Tendinitis of the long palmar muscle tendon. Physiopathology and results of surgical treatment. Apropos of 28 cases].

The results of a 27 cases of flexor carpi radialis tenosynovitis, operated between 1984 and 1992 and followed for an average of 30 months, are reported. This study confirms the female predominance of this disease (25 women for two men) and its development mainly after the age of fifty. Pain along the course of the tendon is a constant sign, frequently associated with dysaesthesia in the territory of the palmaris brevis branch of the median nerve as well as synovial swelling. Surgery was indicated because of failure of apparently correctly conducted medical treatment. The technique consists of synovectomy and resection of all sources of irritation of the tendon in its sheath. The development of trapezium or scaphoid osteophytes is a common cause of irritation. The functional result obtained was good or excellent in 22 cases. This study confirmed the existence of a close relationship between the development of flexor carpi radialis tenosynovitis and the presence of external osteoarthritis of the carpus, as this combination of lesions was observed in 20 of the 27 cases. Carpal osteoarthritic lesions appear to be responsible for the great majority of cases of flexor carpi radialis tendinitis observed in women over the age of 50 years. Following failure of medical treatment, surgical treatment is effective provided it includes treatment of any osteoarthritic lesions present.

Adult↗

PubMed1994

[Late flexor synovitis induced by the use of a fabric lace].

A thirty year old woman underwent trigger finger release of her left middle finger after two injections failed to give relief. Several months later, she developed an area of nodular tenosynovitis localized to the operative site. Her finger had recovered full function, her general health was good, and routine lab work was normal. Because of the persistent mass, flexor tenosynovectomy was performed. Histologic examination revealed synovial hyperplasia associated with a filamentous birefringent foreign material. The bluish color of the foreign material indicated that it came from a fabric retraction loop used during the original operation. She made an uneventful recovery, and three years later her hand remained normal. As a result of this unusual complication, we recommended the use of retraction loops made of plastic rather than fabric. Whenever a micro-foreign body remains in the flexor tendon shealth, there is risk of aseptic tenosynovitis.

Adult↗

PubMed1985

[The median nerve and phlegmons of the digito-carpal sheathes].

While it might seem that compression of the median nerve would be frequent during the course of digitocarpal phlegmonous tenosynovitis, involvement of this nerve under these circumstances is rarely mentioned in the literature. We recently observed two cases of phlegmonous tenosynovitis of the digitocarpal sheath associated with signs of nerve deficits in the territory of the median nerve. This led us to speculate why this phenomenon was so rarely encountered as well as the exact significance of this condition. We believe that the exact place of this association might be situated somewhere between an acute carpal tunnel and a compartment syndrome of the anterior loge of the forearm. An attempt at the description of the semiology of this association is made.

Adult↗

PubMedDate not supplied

An alternative splint design for trigger finger.

Conventional resting splints used to treat digital stenosing tenosynovitis (trigger finger) are often discontinued or not worn consistently by patients. Informal reports by patients indicate that the splints are too bulky, interfere with activities of daily living, and are visibly too noticeable. Since resolution of the condition may take as long as 9 weeks, this is a significant issue. A new splint design has been developed to avoid these shortcomings in hopes that physicians and therapists will have successful compliance when utilizing splinting in the treatment of this condition. It is both cost-effective and noninvasive. This article describes the condition and treatment options for digital stenosing tenosynovitis and fabrication techniques for the proposed alternative splint.

Constriction, Pathologic↗

PubMedDate not supplied

Flexor hallucis longus dysfunction.

Nineteen consecutive cases of flexor hallucis longus stenosing tenosynovitis that underwent operative tenolysis from September 1994 to December 1996 were retrospectively reviewed. This is classically a disorder of ballet dancers, and to a much lesser extent, running athletes. The patients were primarily nonathletic, male, and middle-aged. The mean symptom duration was 20 months, multiple physicians had been encountered, and misdiagnosis was common. Patients presented with overlapping signs and symptoms of flexor hallucis longus tendinitis, plantar fasciitis, and tarsal tunnel syndrome. A cross-reference of patients with posteromedial ankle pain, medial arch pain, and/or a positive Tinel's sign revealed that 14 (74%) and 6 (32%) feet had two of three, or all three signs, respectively. Magnetic resonance imaging and tenography proved valuable in establishing the correct primary diagnosis. Nonoperative protocols were unsuccessful. Flexor hallucis longus tenolysis was successful in each case with a mean return to regular activity at 9 weeks. Flexor hallucis longus stenosing tenosynovitis may be more prevalent than reported and should be a diagnosis of inclusion among all patient populations who present with posterior ankle, medial arch, and/or tarsal tunnel symptoms.

Adolescent↗

PubMed2001

Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay.

This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement.

Arthritis, Rheumatoid↗

PubMed2005

Ultrasound and power Doppler evaluation of the hand and wrist in patients with psoriatic arthritis.

PURPOSE: To evaluate the ability of high-resolution and power Doppler sonography in detecting joint and tendon abnormalities in patients with psoriatic arthritis (PsA) of the hands and wrists compared with clinical and radiological findings. MATERIAL AND METHODS: Thirty-six patients with psoriatic arthritis of the hands and wrists and 10 healthy controls were examined with ultrasound (US). The degree of synovial proliferation, tenosynovitis, presence of joint effusion as well as the vascularity of synovial tissue was estimated. US findings were scored using a newly devised scoring system. RESULTS: Thirty-two patients had articular synovial proliferation and/or tenosynovitis/ tendinitis or joint effusion in one or more joints according to US. Twenty-two patients had tendon changes; only five had joint effusion. The synovial, Doppler, and total articular-teno scores were all significantly correlated to the number of swollen joints. The scores, however, did not correlate to other clinical or laboratory measurements of disease activity. CONCLUSION: US proved effective in demonstrating PsA involvement of the hands and wrists and was more sensitive than clinical examination in detecting pathology. Long-term follow-up studies are needed to evaluate whether this can change the traditional approach for assessing involvement of joints and tendons in PsA.

Arthritis, Psoriatic↗

PubMed2006

Magnetic resonance imaging and radiographic findings of seal finger.

PURPOSE: To describe the magnetic resonance imaging (MRI) and radiographic findings of five patients with seal finger. MATERIAL AND METHODS: The MR images and radiographs of five patients with seal finger were retrospectively evaluated. MRI was performed on four patients in the subacute phase, and follow-up imaging was done on one of them at 5 months. One patient had MRI only at a later stage 5 years after onset. Radiographs were taken three times in the subacute phase and once at a later stage. One patient had had seal finger in another finger previously. RESULTS: Short-tau inversion-recovery (STIR) sequence showed extensive subcutaneous soft tissue edema in all four patients in the subacute phase and tenosynovitis of the flexion tendons in two cases. Three patients had edema in 2-3 phalanges, and effusion in the distal interphalangeal (DIP) joint was seen in one case. At the later stage, no signal pathology in soft tissues or bones was seen in STIR images. In the subacute phase, radiographs showed digital soft-tissue swelling in three patients, and one patient had a narrowed DIP joint, periarticular osteoporosis, and a periosteal reaction. At the later stage, flexion contracture of the finger was seen. CONCLUSION: In addition to soft-tissue infection, seal finger causes bone marrow edema, tenosynovitis, and effusion in the interphalangeal joints visible as increased signal intensity in STIR images. Radiographs reveal periarticular osteoporosis with loss of cartilage in the subacute phase and flexion contracture at the later stage. MRI (STIR) allows more precise delineation of the inflammatory process compared to radiography.

Adult↗

PubMed2000

Comparison of sonography and magnetic resonance imaging for the diagnosis of partial tears of finger extensor tendons in rheumatoid arthritis.

OBJECTIVE: Finger extensor tenosynovitis in rheumatoid arthritis (RA) may lead to partial and eventually to complete tendon tears. The aim of this study was to investigate the diagnostic value of sonography (SG) and/or magnetic resonance imaging (MRI) to visualize partial tendon tears. METHODS: Twenty-one RA patients with finger extensor tenosynovitis for more than 12 months underwent SG, MRI and surgical inspection, the latter being the gold standard. RESULTS: For partial tears, sensitivity and specificity were 0.27 and 0.83 for MRI, and 0.33 and 0.89 for SG, respectively. Positive and negative predictive values were 0.35 and 0.78 for MRI, and 0.50 and 0.80 for SG, respectively. Accuracy was 0.69 for MRI and 0.75 for SG. CONCLUSION: For visualization of partial finger extensor tendon tears in RA patients, SG performs slightly better than MRI, but both techniques are at present not sensitive enough to be used in daily practice.

Adult↗

PubMedDate not supplied

MRI of musculoskeletal extraspinal tuberculosis.

PURPOSE: The aim of this study was to describe the MR findings in extraspinal musculoskeletal tuberculosis (EMT). METHOD: A retrospective review was conducted of the MR findings of 18 patients with microbiologically and/or pathologically proven EMT. All MR studies were performed using T1-and T2-weighted spin echo sequences. T1-weighted spin echo sequences after Gd-DTPA injection were obtained for 12 patients. The MR images were evaluated for abnormalities in joints, bones, and soft tissues, and the results were grouped by anatomic localization, frequency distribution of structures affected, and morphologic patterns of involvement. RESULTS: Isolated soft tissue tuberculosis was found in 10 (55.5%) patients and involvement of more than one structure in 8 (44.4%). Pyomyositis (n = 6) and arthritis with involvement of adjacent soft tissues (n = 7) were the most common forms of presentation. One patient presented with isolated fascial superficial tissue involvement in one leg. Isolated pyomyositis involving one (n = 3) or two (n = 3) muscles was homogeneous in six cases and showed intermediate (n = 6), low (n = 2), or high (n = 1) signal intensity on T1-weighted images and a high and very hyperintense signal on T2-weighted images. The tenosynovitis synovial fluid was homogeneous (n = 1) or heterogeneous with multiple tiny hypointense nodules (n = 1) on T2-weighted images. The subdeltoid bursitis fluid was characterized by homogeneous low signal intensity with a hyperintense rim (n = 2) on T1-weighted images and homogeneous (n = 1) or heterogeneous hyperintense signals with areas of low signal intensity (n = 1) on T2-weighted images. In tuberculous arthritis, the synovial joint fluid (n = 7) showed heterogeneous (n = 4) or homogeneous (n = 3) low signal intensity on T1-weighted images and high or very high signal intensity on T2-weighted images. Where involved, the adjacent muscle(s) (n = 8) were usually hypointense on T1-weighted images and very hyperintense on T2-weighted images. Associated cellulitis was found in arthritis with involvement of neighboring soft tissues (n = 5), pyomyositis (n = 2), and tenosynovitis (n = 1). The images obtained after Gd-DTPA showed peripheral (n = 10) or heterogeneous (n = 1) enhancement or no enhancement (n = 1). CONCLUSION: The MR findings for EMT are variable. Although diagnosis is dependent largely on prior presumption and clinical context, MRI provides valuable guidelines in defining the extent of the lesions to select the appropriate treatment and for follow-up of abnormalities.

Adolescent↗

PubMed1991

Trigger finger secondary to anomalous lumbrical insertion: a case report and review of the literature.

Trigger finger is a relatively common clinical entity, most frequently caused by stenosing tenosynovitis. Several other conditions not related to tenosynovitis also have been described as a cause of triggering, and these have been reviewed. We present a rare anomaly of the fourth lumbrical muscle insertion as a cause of triggering of the right little finger. This was completely relieved following excision of the anomalous muscle. This rare anatomic variant should be added to the list of potential causes of trigger finger.

Adult↗