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Infectious tenosynovitis (viral arthritis): influence of maternal antibodies on the development of tenosynovitis lesions after experimental infection by day-old chickens with tenosynovitis virus.

When chicks with maternal antibodies against infectious tenosynovitis (viral arthritis) virus were inoculated orally at 1 day old with tenosynovitis virus, they were protected against developing active tenosynovitis lesions 3 weeks later. They were not protected against subcutaneous inoculation, however. Breeder vaccination against tenosynovitis resulted in immunity of the progeny against oral infection at 1 day old, whereas progeny from unvaccinated breeders were susceptible to such a challenge.

Animals

Heterophil function in healthy chickens and in chickens with experimentally induced staphylococcal tenosynovitis.

Heterophil function was evaluated in 16 healthy chickens and in 46 chickens with experimentally induced staphylococcal tenosynovitis. In paired blood samples, heterophils from chickens with tenosynovitis had a significant increase in adherence, chemotaxis, phagocytosis, and bacterial killing of Staphylococcus aureus compared to heterophils from healthy chickens. The percent adherence of heterophils to nylon fiber columns increased significantly from a 78.4% mean +/- 6.6% standard deviation to 87.6% +/- 3.2% after induction of staphylococcal tenosynovitis. Heterophil movement following in vitro exposure to saline or endotoxin was increased in chickens with tenosynovitis; 3 +/- 1 heterophils/0.25 mm2 to 10 +/- 6 heterophils/0.25 mm2 and 136 +/- 29 heterophils/0.25 mm2 to 340 +/- 74 heterophils/0.25 mm2, respectively. Endotoxin-activated serum was chemoattractive for heterophils from all chickens. Flow cytometry was used to define the heterophil population on light scatter histograms, evaluate individual cell phagocytosis of latex beads, and quantitate the number of beads phagocytosed per heterophil. When incubated with increased numbers of beads, only heterophils from chickens with tenosynovitis phagocytosed higher numbers of beads. At heterophil to bead ratios of 1:10, the percentage of heterophils that phagocytosed beads increased from baseline values of 37.8% +/- 9.0% to post-infection values of 67.3% +/- 7.5%. Using 1:20 heterophil to bead ratios, heterophil phagocytosis increased from 38.7% +/- 9.9% to post-infection values of 79.8% +/- 7.3%. Heterophils from all chickens were able to phagocytose and kill log phase staphylococcal bacteria. After phagocytosis, the heterophils from chickens with staphylococcal tenosynovitis rapidly decreased the number of viable bacterial colony forming-units per milliliter by approximately one log.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Distal stenosing tenosynovitis.

Three patients are described with distal stenosing tenosynovitis involving the flexor digitorum profundus and the A3 pulley. One patient had isolated distal stenosing tenosynovitis and two patients had combined distal and proximal stenosing tenosynovitis of the flexor digitorum superficialis and the A1 pulley. All three patients with four digits involved had improvement of their symptoms after release of the A3 pulley. When involved, the A1 pulley was released at the same time. Patients with proximal stenosing tenosynovitis may have an associated distal stenosing tenosynovitis that if overlooked may cause persistence of symptoms after surgical treatment.

Adult

[Tenosynovitis nodosa].

Nodular tenosynovitis occurs in a localized and in a diffuse form. The histologie finding are rather variable. According to electron microscopic studies nodular tenosynovitis originates in the synovial membrane. Mainly there are two types of cells to be found in the tumor: Type A, similar to macrophages - type B, similar to fibroblasts. The localized form of nodular tenosynovitis has a higher incidence in woman and occurs predominantly in the hand. The clinical symptoms are not characteristic and usually not very pronounced. More than one tumor in a single patient and also bone erosions caused by nodular tenosynovitis are rare occurrences. A case of a patient with multilocular occurrence of tenosynovitis is described here.

Elbow

Tenosynovitis of the hand: a forgotten manifestation of tuberculosis.

Once the most common form of chronic tenosynovitis of the hand, tenosynovitis due to Mycobacterium tuberculosis has become rare. Descriptions of this clinical entity can no longer be found in medical textbooks. Because of the rarity of this condition, diagnosis is frequently delayed. We present a case and review the presentation, diagnostic criteria, and treatment of tuberculous tenosynovitis. The relation of this infection to antecedent trauma and Dupuytren's contracture is discussed. M. tuberculosis should be considered in patients with chronic or recurrent tenosynovitis.

Aged

Haemophilus influenzae tenosynovitis.

A case is reported of polytenosynovitis in a 31-year-old male during the course of a severe bacteraemic illness caused by Haemophilus influenzae type b. The clinical presentation was similar to tenosynovitis caused by bacterial or viral agents. As the management of the H. influenzae tenosynovitis would differ from that due to other causes, the addition of H. influenzae type b to a differential of tenosynovitis should be considered. Recognition and prompt treatment by appropriate antibiotics may be important to avoid suppurative complications affecting the tendons. As the pathophysiology of the tenosynovitis is not clear, careful bacteriological and immunological assessment must be obtained.

Adult

Stenosing flexor tenosynovitis.

A review of 253 consecutive digits with stenosing flexor tenosynovitis was done to clarify the respective role of steroid injection and surgical release in the management of stenosing flexor tenosynovitis. Treatment selection was based on the patient's age and severity of presenting complaints. In patients aged 10 years or more, analysis showed no statistically significant difference between results with steroid injection and surgical release. Surgical treatment was associated with higher cost and more complications. Based on this review, we recommend up to three injections of 20 mg of triamcinolone into the digital flexor sheath as the initial management of nonlocking, stenosing flexor tenosynovitis in adults. Initial management by surgical release is reserved for children and patients with digits locked in flexion.

Adolescent

Incidence of tenosynovitis or peritendinitis and epicondylitis in a meat-processing factory.

A 31-month follow-up study on the incidence of clinically ascertained tenosynovitis or peritendinitis in the hand and forearm regions and epicondylitis was conducted among 377 workers in strenuous manual jobs and 338 employees in manually nonstrenuous work in a large meat-processing factory. The clinical diagnosis of tenosynovitis or peritendinitis occurred 143 times and epicondylitis 68 times during the follow-up. The annual incidence of tenosynovitis or peritendinitis was less than 1% for employees in nonstrenuous jobs, 25.3% for female packers, 16.8% for female sausage makers, and 12.5% for male meatcutters. The annual incidence of epicondylitis was about 1% for employees in nonstrenuous jobs, 11.3% for female sausage markers, 7.0% for female packers, and 6.4% for male meatcutters. Workers typically resumed their jobs after returning from sick leave, and job transfers were rare.

Cohort Studies

[De Quervain's tenosynovitis. Transversal scar and fixation of the capsular flap].

The authors report 62 cases of De Quervain tenosynovitis treated from 1983 to 1990 by the same surgeon. The de Quervain's tenosynovitis is an inadequation between the volume of the abductor pollicis longus and the extensor pollicis brevis and their tunnel above the radial styloid process producing a mechanical tenosynovitis. This disease occurs mostly in women with an average age of 47 and almost never before the age of 30. Clinically the patients have pain and swelling above the radial styloid process. Most of the surgeons know today this disease, nevertheless complications may occur (Abductor pollicis longus luxation, disgratious enlargement and adhesion of the scar). The transversal incision provides a less disgracious scar. As the tendinous pulley is opened frequent anatomical variations of the tendons are found. A ventral capsular flap fixation with a subcuticular continuous suture is made. This fixation prevents any ventral luxation. Radial nerve neuromas or neuritis is constantly looked for. The authors expose and analyse the statistical data of this intervention's results with a 6 month minimal and 7 years maximal follow up.

Adolescent

Septic tenosynovitis in horses: 25 cases (1983-1989).

The medical records of 25 horses with septic tenosynovitis treated over 7 years (1983 to 1989) were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with septic tenosynovitis was 5 years (range, 1 month to 21 years). Fourteen fore limbs and 11 hind limbs were affected. Sepsis was located in the sheath of the digital flexor tendons of 22 horses. Sepsis was located in the sheath of the extensor carpi radialis tendon (1 horse), sheath of the long digital extensor tendon (1 horse), or sheath of the common digital extensor tendon (1 horse) in the remaining horses. Nine horses received only medical treatment, using a combination of broad-spectrum parenterally administered antimicrobial drugs (8 of 9 horses), nonsteroidal anti-inflammatory drugs (8 of 9 horses), or irrigation of the wound (4 of 9 horses). Fourteen horses were treated surgically with either transection of the palmar/plantar annular ligament of the metacarpo/metatarsophalangeal joint (5 of 14 horses), lavage of the sheath after insertion of drains into the sheath (7 of 14 horses), or both (2 of 14 horses). All horses treated surgically were concurrently treated parenterally with broad-spectrum antimicrobial drugs and nonsteroidal anti-inflammatory drugs. Two horses with septic tenosynovitis were not treated and were euthanatized at the owners' request. Five horses were euthanatized before discharge from the hospital. Two horses (both treated medically) were lost to follow-up. Follow-up information was obtained for 18 horses, 6 to 55 months after discharge from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

[Tendinitis and tenosynovitis of the wrist].

Tendinitis and tenosynovitis of the wrist are often encountered in daily medical practice. This frequency is due to the long course of the tendons over the wrist, to the role played by these tendons in the mobilization and stabilization of that joint and to overuse of the hand in daily life as well as in professional and sporting activities. In their common form tendinitis and tenosynovitis are benign and episodic diseases which may present under two aspects: straightforward tenosynovitis with exsudation, crepitus, stenosis or adhesion, and tendinitis at the sites of attachment. In certain cases the condition is specific and of infectious or inflammatory origin. The diagnosis is based on questioning and on the demonstration, during examination, of a symptomatic triad characterized by resurgence of pain at palpation, inducement of passive tension of the tendon, and resisted muscular contraction. Treatment is based on local injections of corticosteroids and rest. Surgery is seldom indicated.

Humans

The effect on newborn chicks of oral inoculation of reovirus isolated from chickens with tenosynovitis.

Reovirus strain 176, isolated from chickens with tenosynovitis, was highly pathogenic following oral inoculation of 1-day-old specific-pathogen-free chicks. Disseminated lesions including hepatic necrosis, splenic lymphostromal cell hyperplasia, and bursal atrophy occurred on day 3 postinoculation (PI), followed by myocarditis on day 6 PI and by pericarditis and tenosynovitis on day 9 PI. Reovirus was isolated from the liver as early as day 1 PI, whereas significant neutralizing antibody was detected on day 13 PI. Mortality occurred from day 4 to day 7 PI, and the death of birds was associated with the severity of hepatic necrosis. The occurrence of tenosynovitis in virus-inoculated birds was subclinical.

Animals

Hand flexor tenosynovitis in rheumatoid arthritis. Prevalence, distribution, and associated rheumatic features.

Tenosynovitis of one or more flexor tendons of the hand (mean 3.1 tendons per patient) was noted in 55% of 100 patients with rheumatoid arthritis (RA) examined periodically during a mean period of 5 years. The third flexor tendon was involved most frequently (71% of patients), followed by the second (62%), fourth (53%), fifth (27%), and first (13%). Patients with flexor tendonitis (FT) had a significantly higher prevalence of rheumatoid nodules (56% vs 33%), carpal tunnel syndrome (47% vs 13%), wrist extensor tenosynovitis (47% vs 9%), and elbow epicondylitis (22% vs 7%) than patients without FT. Dupuytren's contracture, DeQuervain's tenovaginitis, flexor carpi radialis and ulnaris tendonitis, and Achilles tendonitis were found exclusively in patients with FT. A control group of 50 non-RA patients with FT had statistically fewer diseased tendons per patient (mean 1.5) and a different digital distribution, the thumb being affected more frequently (P less than 0.05) than in RA patients.

Achilles Tendon

Intratendon sheath corticosteroid treatment of rheumatoid arthritis-associated and idiopathic hand flexor tenosynovitis.

Flexor tenosynovitis (FT) is a common manifestation of rheumatoid arthritis (RA), contributing to hand deformity and manual dysfunction. The efficacy of intratendon sheath corticosteroids was assessed by reviewing the results of such treatment in 173 episodes of FT documented in 46 patients with definite or classic RA. Ninety-three percent of initial episodes resolved completely for 3 or more months (median: 25 months); tenosynovitis did not recur in 59%. The likelihood of a favorable response did not diminish with treatment of recurrent FT in a given digit. Comparable results were found in 52 FT episodes observed in 38 non-RA patients. No tendon sheath or soft tissue infection or tendon rupture ensued in either treatment group. The response was influenced by the specific corticosteroid preparation selected. Based on this experience, a trial of intratendon sheath corticosteroid injections prior to surgical intervention is recommended for RA patients with FT.

Arthritis, Rheumatoid

Treatment of De Quervain's tenosynovitis with corticosteroids. A prospective study of the response to local injection.

Fifty-six cases of De Quervain's tenosynovitis (in 55 patients) were treated with a "long-acting" corticosteroid, methylprednisolone acetate, and followed prospectively over a 4-year period. Approximately 90% of these patients were effectively managed either with a single injection (58%) or with multiple injections (33%) of this compound. Seventeen patients experienced recurrence a mean of 11.9 months after the initial injection. Three had minor flares and were not reinjected; the others responded to reinjections. Ten percent of the cases could not be controlled with local injection, and these patients were referred for surgery. Adverse reactions were self-limited and relatively minor; no tendon ruptures or local infections occurred. We present a discussion of our review of the literature regarding medical therapy and surgical release for this condition. Treatment of De Quervain's tenosynovitis with methylprednisolone acetate injection rapidly controls the signs and symptoms, does not lead to serious adverse reactions, and should be the preferred initial treatment.

Adult

Use of sonography in the early detection of suppurative flexor tenosynovitis.

Eighteen patients with swollen fingers suggesting acute suppurative tenosynovitis were studied by ultrasonography. All patients received intravenous antibiotics. Twelve patients required surgical drainage. Eleven of 12 patients had sonographic evidence of both a swollen tendon and fluid in the flexor sheath. Eleven of the 12 patients operated on had purulent fluid in the flexor sheath. Four of the operative cases were culture positive and four were culture negative. All six patients treated only with antibiotics had swollen tendons, but five of the six had no sonographic evidence of fluid in the flexor sheath. All patients had a full recovery. Sonographic evidence of fluid in the flexor sheath is a useful sign in the early diagnosis of acute suppurative flexor tenosynovitis.

Adult

Suppurative extensor tenosynovitis caused by Staphylococcus aureus.

Suppurative tenosynovitis is a rare infection, occurring almost exclusively in the flexor tendon sheath as a posttraumatic event. We report the case of a systemically ill woman with suppurative tenosynovitis of the extensor tendons caused by Staphylococcus aureus. Early recognition of this unusual infection may prevent unnecessary morbidity.

Female

Hepatitis B presenting with tenosynovitis.

A 31-year-old nurse's aide developed fever, malaise, migratory arthralgias, arthritis, and severe tenosynovitis six weeks after pricking her finger with a needle contaminated by blood from a patient having type B viral hepatitis. Although disseminated Neisseria gonorrhoeae infection was the initial diagnosis, her symptoms worsened on treatment with ampicillin. While the patient was on aspirin therapy, her symptoms improved dramatically and eventually resolved as she showed evidence, through laboratory findings, of an anicteric hepatitis B infection. Evidently tenosynovitis can be part of the hepatitis B prodrome.

Adult