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PubMed2001

Comparison of extracapsular changes by magnetic resonance imaging in patients with rheumatoid arthritis and polymyalgia rheumatica.

OBJECTIVE: Joint inflammation in polymyalgia rheumatica is regarded primarily as a disease of the synovial cavities and bursae, but the adjacent capsules and soft tissues have not been evaluated using sensitive imaging methods. We used fat suppression magnetic resonance imaging (MRI) to determine anatomical sites of inflammatory change in the shoulders of patients with early polymyalgia rheumatica (PMR) and a control group of patients with rheumatoid arthritis (RA). METHODS: Fourteen patients with PMR and 14 with RA (a total of 20 shoulders in each group) were evaluated. T2 SPIR (fat suppressed) coronal oblique MRI sequences of the shoulders were performed. Scans were assessed for sites of joint effusion, bursitis, tenosynovitis, bone edema, and extracapsular soft tissue edema. Statistical analysis was performed using Fisher's test. RESULTS: Nine of 14 patients (10/20 joints) with PMR but only 2/14 (2/20 joints) with RA had prominent edema at extracapsular sites adjacent to the joint capsule or in the soft tissues (p = 0.02). Both groups had a comparable degree of joint effusion (18 PMR, 17 RA), bursitis (18 PMR, 16 RA), and tenosynovitis (3 PMR, 2 RA). CONCLUSION: The only significant difference between the 2 groups was the presence of inflammatory change outside the joint cavity in patients with PMR. This may contribute to the diffuse nature of symptoms in PMR and have implications for its pathogenesis.

Adult↗

PubMed2001

[Overuse injury syndromes of the hand, forearm and elbow].

The basic role of the shoulder, upper arm, elbow, forearm, and wrist is to place the hand in the appropriate position, so that it can fulfill its function. The upper extremity, especially the wrist and the hand, has a very complex anatomy with a large number of bones, muscles, tendons and nerves. They are essential to work and sport activities and are subject to acute and/or chronic mechanical injuries. This is why overuse injuries are the most common in these regions. They are often characterised by tendinitis, tenosynovitis, tunnel syndromes, or stress fractures. This paper gives an overview of the most common overuse syndromes of the hand, wrist, forearm and elbow, describing their characteristic symptoms and methods of diagnosis and treatment. The syndromes are trigger finger, dorsal radiocarpal impingement syndrome (gymnast's wrist), DeQuervain's disease, tenosynovitis of other dorsal compartments, intersection syndrome (oarsman's wrist), flexor carpi ulnaris tendinitis, flexor carpi radialis tendonitis, humeral epicondylitis (tennis elbow), posterior impingement syndrome of the elbow, medial tension and lateral compression syndrome, stress fracture in the hand, wrist, forearm and elbow, and tunnel syndromes.

Cumulative Trauma Disorders↗

PubMedDate not supplied

Intralesional therapy in carpal tunnel syndrome: a sonographic-guided approach.

OBJECTIVE: The aim of this pictorial essay is to show a representative example of sonographic-guided injection in carpal tunnel syndrome associated with tenosynovitis of the finger flexor tendons. METHODS: Images were obtained using a real-time ultrasound system (AU4-idea; Esaote Biomedica, Genoa, Italy) equipped with a 13-MHz linear transducer. The best injection site was detected using a fine metal clip placed between the skin and the transducer. The images here were obtained in a patient with rheumatoid arthritis and carpal tunnel syndrome secondary to tenosynovitis of the finger flexor tendons. RESULTS: Steroid injection within the carpal tunnel under sonographic control was easily performed. All steps of the needle placement within the widened tendon sheath were carefully evaluated on the monitor screen. Marked clinical improvement occurred shortly thereafter (3 days) and increased over the next 6 weeks. CONCLUSION: A detailed assessment of the carpal tunnel and a correct, safe placement of the needle for steroid injection can be quickly performed under sonographic guidance.

Carpal Tunnel Syndrome↗

PubMed2004

Fat suppression magnetic resonance imaging in shoulders of patients with polymyalgia rheumatica.

OBJECTIVE: To evaluate the sites of inflammatory process in the shoulders of patients with polymyalgia rheumatica (PMR) using fat suppressed magnetic resonance imaging (MRI). METHODS: Six consecutive, untreated new patients with PMR were investigated. Five patients with early rheumatoid arthritis (RA) and 4 patients with early psoriatic arthritis (PsA) with bilateral shoulder symptoms served as a control group. Bilateral shoulder fat-suppressed MRI sequences were performed in all patients and controls. We evaluated the presence of joint synovitis, bursitis, tenosynovitis, and bone and soft tissue edema. RESULTS: Bilateral subacromial/subdeltoid bursitis was found in all patients with PMR, in 1/5 (20%) patients with RA (p < 0.05), and in none with PsA (p < 0.02). Glenohumeral synovitis was present in all case and controls. Biceps tenosynovitis was observed in 4/6 (67%) patients with PMR, in 4/5 (80%) with RA (not significant, NS), and in all 4 patients with PsA (NS). No evidence of bone edema adjacent to the joint capsule and entheseal insertions or in the soft tissues was present in either cases or controls. CONCLUSION: The absence of extracapsular abnormalities in the early shoulder disease of PMR does not confirm the hypothesis of a capsular-based disorder.

Aged↗

PubMedDate not supplied

Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study.

OBJECTIVE: To define joint alterations in the wrists of patients with systemic lupus erythematosus (SLE) by ultrasonography (US). METHODS: Fifty-two wrists of 26 SLE patients and 30 wrists of 15 healthy controls were evaluated using US by two different experienced operators, blinded to the clinical data. A 14 MHz linear probe was used. Power Doppler (PD) was applied to evaluate the presence of synovial neoangiogenesis as a parameter of active local synovitis. The findings were correlated to the clinical evaluation, serological systemic disease activity parameters (ESR, C3 levels) and the SLE-disease activity score (SLEDAI). Statistical analysis was performed by the EPISTAT program. RESULTS: Signs of synovitis were found in 22 wrists (42.3%). Synovial proliferation was present in 10 joints (19.2%), PD positivity in 5 (9.6%) and joint effusion in 13 (25%). Erosions were present in both wrists (3.8%) of one patient. Signs of tenosynovitis of one or more tendons were shown in 23 cases (44.2%). Ganglia were found in 2 joints (3.8%). Changes of the median nerve, joint dislocations, tendons' ruptures, cysts and nodules were never detected. In 14 wrists (26.9%) no alterations were found. There was no correlation between sonographic findings and clinical, laboratory and indexes signs of disease activity. In the control group the only alteration found was tenosynovitis in 1 joint (p < 0.0001). CONCLUSION: US proved to be an useful technique to detect wrist joint alterations in SLE. These findings may help the physician to modulate treatment strategies and to perform a low cost monitoring of joint disease activity.

Adult↗

PubMedDate not supplied

Comparative study of the pathogenicity of avian reoviruses.

Reovirus strains CO8 and 81-5, isolated from chickens with malabsorption syndrome, and reovirus strain 176, isolated from chickens with tenosynovitis, were each individually inoculated into 1-day-old specific-pathogen-free chicks. Strain CO8 caused tenosynovitis and pericarditis following footpad inoculation, but it was of low pathogenicity when given by either oral or subcutaneous route. In contrast, strains 81-5 and 176 were highly pathogenic and caused severe mortality following subcutaneous inoculation. Lesions included hepatic necrosis, bursal atrophy, thymitis, and splenic hyperplasia; strain 81-5 also caused pericarditis and myocarditis. Although strain 176 caused higher mortality than strain 81-5, these two strains differed little in the severity and distribution of the lesions they caused. No signs or lesions of typical malabsorption syndrome were observed.

Animals↗

PubMed1985

Synovectomy of the hand and wrist.

Synovectomy of tendons gives excellent results with rare recurrence. This is because the local environment is altered from a closed space into a decompressed area of healthy fat. The synovium can invade and destroy tendon, cartilage or bone when in a closed space and under pressure. Unfortunately, the environment can not be so altered in a joint. Joint synovectomy, however, is the only procedure available to prolong function of the patient's own joint (and relieve pain) for an "X" amount of time, which depends upon the course of the generalized disease. After two to three years, the result of a synovectomy is dependent upon the course of the general disease activity and not the surgery. It is absolutely necessary that general medical treatment be carried on before, during, and after surgery, as the surgery is only one incident, often dramatic, in total care of the patient. Chemical synovectomy of the hand has been shown to have variable results with only short-term gains being noted. Surgical synovectomy is indicated when synovitis persists in spite of adequate medical management and there is pain and early correctible deformities. Besides removing the synovium, it is necessary to reconstruct the capsular support and correct alignment. Flexor tenosynovitis in the fingers should be treated with decompression of the digital sheath, not incising the pulley system due to the possibility of accentuating the forces causing ulnar drift. Dorsal tenosynovitis in the wrist is treated by tenosynovectomy, synovectomy, resection of the distal ulna, reconstruction of the ulnar side of the wrist and transposition of the dorsal carpal ligament beneath the extensor tendons.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗

PubMed1985

[Gonorrhea and pustules of the hands].

Two similar cases of disseminated infection by Neisseria gonorrhoeae were observed at the same time. The patients presented with fever, arthralgia, tenosynovitis, cutaneous pustules of the extremities. In one case, N. gonorrhoeae has been recovered from vaginal discharge; in the other, bacteriological investigations failed. From a review of the literature, it appears that: (1) acral vesiculo-pustular lesions and tenosynovitis represent the most suggestive signs of the disease; (2) it is obviously important to repeat the bacteriological investigations; (3) biological data, included serology, are useless. However, immunofluorescence techniques might detect altered germs in the skin.

Adult↗

PubMed1985

Tendon sheath infections of the hand.

Septic tenosynovitis continues to be a serious condition of the hand. Complications, sometimes necessitating amputation, are not uncommon. We studied the anatomic arrangements of the flexor tendon sheaths and were able to demonstrate different synovial compartments within the one osteofibrous tendon sheath. This has important consequences for surgical therapy. 48 Patients are reported operated on for tendon sheath infection over a 10-year period. All data influencing the end-result are analysed, with particular attention to delay in operative treatment, the results of bacterial cultures, the use of antibiotics and the surgical technic itself. When tenosynovitis is suspected, immediate drainage of all the different compartments of the tendon sheath is required.

Drainage↗

PubMed1982

[Carpal tunnel syndrome due to mycobacterium bovis BCG (author's transl)].

A 45-year-old woman, previously in good health developed chronic tenosynovitis with carpal tunnel syndrome a few weeks after wounding herself with a Pasteur pipette containing BCG cultures. She had received two injections of triamcinolone in the anterior annular ligament of the right carpa. The patient recovered after twelve months of antituberculous therapy associating isoniazid (300 mg/day), ethambutol (800 g/day), and rifampicine (400 mg/day). This is the first report of BCG tenosynovitis of the hand. The hazards of steroid injections into the tendon sheaths are pointed out.

Antitubercular Agents↗

PubMed1984

Foreign body granuloma. A cause of trigger thumb.

Snapping or triggering of fingers is a common complaint, the most frequent cause being tenosynovitis of the flexor tendon sheath. Injury of the flexor tendon as a precursor of triggering is infrequent. Foreign body granuloma of the tendon sheath as an antecedent factor has not been yet recorded. We report a case of stenosing tenosynovitis of the flexor tendon of the thumb caused by local reaction to a foreign body.

Accidents, Occupational↗

PubMed1994

[Preoperative evaluation of tendons in the hands of patients with rheumatoid arthritis by ultrasonography].

The findings of ultrasonography (US) of 52 tendons of the hands of 14 patients with chronic rheumatoid arthritis (RA) were compared with operative findings obtained subsequently. US showed tenosynovitis as expansion of a hypoechoic area around the tendon. US also enabled pattern classification based on shape, internal echo and border features of the scanned tendon, differentiation of acute and progressive stages among acute inflammation, invasion of tenosynovitis, degeneration, and rupture of the tendon to be made, and the progression of tendon lesions could be ascertained. It was found that in inflammation the tendon was significantly thickened, and in degeneration, the tendon was thinned. By dynamic US scanning, disturbances of tendon movement due to tendon rupture and adhesion to surrounding structures could be detected and differentiated. It was found in this study that preoperative US of the hand of RA patients is very useful for early diagnosis and for the selection of treatment including operative methods.

Adult↗

PubMed1997

On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895.

This paper represents the first English translation of the original article "On A Form Of Chronic Tendovaginitis" by Fritz de Quervain, published in 1895. This classic paper describes the natural history, symptomatology, pathology, and etiology of stenosing tenovaginitis of the first dorsal compartment (de Quervain's tenosynovitis). Dr. de Quervain also discusses the differential diagnosis for this disorder, his approach to management of the problem, and the results of surgical treatment in this series of collected patients. The paper concludes with a brief discussion of trigger digits. In addition to providing a classic description of the disease, the paper makes the following points that should prove of particular interest to the orthopedic surgeon. First, the term "de Quervain's tenosynovitis" is a misnomer. In fact, Dr. de Quervain credits Dr. Kocher with the first description of the disease and its first surgical treatment. Second, treating orthopedists have much to learn from this eloquent description of a common problem, particularly because the management of this disease has changed little since de Quervain's paper was first published.

History, 19th Century↗

PubMed2003

Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging.

OBJECTIVE: To determine the role of ultrasound and magnetic resonance imaging (MRI) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis (RA) of the shoulder joint. METHODS: Forty-three consecutive patients with known RA prospectively underwent clinical examination, radiography, ultrasound, and MRI of the shoulder joints. Each patient was assigned a clinical/laboratory score consisting of 7 parameters, including measurements of shoulder mobility, the erythrocyte sedimentation rate, and C-reactive protein level. Conventional radiography was standardized and performed in 2 planes. Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer. MRI at 1.5T comprised transverse and oblique coronal T1- and T2*-weighted fast spin-echo, gradient-echo (GRE), and inversion-recovery sequences with a matrix size of up to 512 pixels. A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium. Erosions were assessed using all 3 imaging techniques on a 4-point scale. Soft-tissue involvement was evaluated according to the presence of synovitis, tenosynovitis, and bursitis on ultrasound and MRI. The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain. RESULTS: In the study group, erosions of the humeroscapular joint were detected by conventional radiography in 26 patients, by ultrasound in 30 patients, and by MRI in 39 patients; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI (P < 0.0001). Conventional radiography detected 12 erosions of the scapula and MRI detected 15. Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI (P = 0.0003). Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI (P = 0.0064). Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI. The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI (P < 0.05). CONCLUSION: Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint. Although conventional radiography can be used as the sole method of following up known joint destruction in RA, ultrasound and, preferably, MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results.

Adult↗

PubMed1999

Unilateral distal extremity swelling with pitting oedema in giant cell arteritis.

We describe a case of an 82-year-old woman with giant cell arteritis, who developed unilateral pitting oedema of the dorsum of the right hand, foot and distal part of the right forearm as well as tenosynovitis of the right wrist extensors, mild synovitis of the right wrist, metacarpophalangeal and metatarsophalangeal joints, during relapse of giant cell arteritis. Increase of corticosteroids resolved the giant cell arteritis, pitting oedema and tenosynovitis.

Aged↗

PubMed2006

Optimization design of thumbspica splint using finite element method.

De Quervain's tenosynovitis is often observed on repetitive flexion of the thumb. In the clinical setting, the conservative treatment is usually an applied thumbspica splint to immobilize the thumb. However, the traditional thumbspica splint is bulky and heavy. Thus, this study used the finite element (FE) method to remove redundant material in order to reduce the splint's weight and increase ventilation. An FE model of a thumbspica splint was constructed using ANSYS9.0 software. A maximum lateral thumb pinch force of 98 N was used as the input loading condition for the FE model. This study implemented topology optimization and design optimization to seek the optimal thickness and shape of the splint. This new design was manufactured and compared with the traditional thumbspica splint. Ten thumbspica splints were tested in a materials testing system, and statistically analyzed using an independent t test. The optimal thickness of the thumbspica splint was 3.2 mm. The new design is not significantly different from the traditional splint in the immobilization effect. However, the volume of this new design has been reduced by about 35%. This study produced a new thumbspica splint shape with less volume, but had a similar immobilization effect compared to the traditional shape. In a clinical setting, this result can be used by the occupational therapist as a reference for manufacturing lighter thumbspica splints for patients with de Quervain's tenosynovitis.

De Quervain Disease↗

PubMed2005

A modified thumb spica splint for thumb injuries in the ED.

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.

Emergency Medicine↗

PubMed2004

MR imaging: arthropathies and infectious conditions of the elbow, wrist, and hand.

The superior soft tissue contrast and multiplanar capability of MR imaging has contributed to earlier diagnosis and implementation of effective treatment for a variety of arthropathies and infectious conditions of the elbow, wrist, and hand. Because of overlapping clinical signs and symptoms, MR imaging plays an important role in delineating the features and staging of each of these conditions. This article discusses the seropositive and seronegative inflammatory arthropathies, with emphasis on early detection and surveillance, as well as gout, synovial osteochondromatosis, pigmented villonodular synovitis, tenosynovitis, and de Quervain's tenosynovitis. Certain noninflammatory arthritides and infectious conditions are also reviewed.

Bacterial Infections↗