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PubMed1996

Mycoplasma bovis-associated pneumonia and arthritis complicated with pyogranulomatous tenosynovitis in calves.

Immunohistochemistry and bacteriologic culturing were used to detect Mycoplasma bovis in tissue specimens from feedlot calves affected with pneumonia and arthritis. Two herds with 110 Charolais calves and 25 Angus calves were examined. Clinical signs included severe respiratory distress, anorexia, pyrexia, and lameness, which affected nearly a third of the calves. Lung lesions were characterized by numerous abscesses. Synovial lesions of the limbs included pyogranulomatous tenosynovitis, bursitis, and synovitis, particularly in the areas of the carpal and elbow joints. Abscesses in lung and synovial tissues contained accumulations of M bovis antigens, as revealed by immunohistochemistry. The findings of this report indicate that infection with M bovis may result in a pneumonia-arthritis syndrome with pyogranulomatous lesions in calves.

Abscess↗
PubMed1996

Tissue pressures in pyogenic flexor tenosynovitis of the finger. Compartment syndrome and its management.

We investigated 14 patients with pyogenic flexor tenosynovitis for increased tissue pressures in involved digits. All showed raised pressures, in eight to 30 mmHg or more. These levels are consistent with a compartment syndrome. We describe the results of a modified operative technique which includes irrigation of the sheath and the leaving open of a lateral incision. This also allows early active mobilisation of the finger and has given satisfactory early results.

Adolescent↗
PubMed1997

Use of tenoscopy for management of septic tenosynovitis caused by a penetrating porcupine quill in the synovial sheath surrounding the digital flexor tendons of a horse.

A 6-year-old Quarter Horse gelding with acute onset of a grade-4/5 lameness of the left forelimb 21 days after an encounter with a porcupine was examined. Quills had been removed by the referring veterinarian, and the horse had been treated with antibiotics and hydrotherapy for 14 days. The horse was pyretic and had effusion in the digital synovial sheath. Signs of pain were elicited on palpation of the area. A tentative diagnosis of septic tenosynovitis caused by a porcupine quill was made. Exploratory tenoscopy revealed large amounts of fibrin in the sheath and a 1.2-cm quill. Bacteriologic culture of synovial fluid yielded a pure growth of Staphylococcus aureus. The horse improved dramatically after tenoscopic removal of the quill, debridement of fibrin, and lavage to dilute inflammatory mediators and bacteria, debridement of fibrin, discovery and removal of a quill, and complete evaluation of the sheath for prognostic purposes. Tenoscopy can provide a means for direct observation and enhance the ability of clinicians to debride a septic synovial sheath in a minimally invasive manner.

Animals↗
PubMed1997

[Ultrasonic diagnosis of De Quervain's stenosing tenosynovitis].

This study was aimed at stressing the role of US of the first dorsal compartment of the wrist as the initial diagnostic approach in the study of De Quervain's syndrome, thanks to the high diagnostic yield of this technique. We report on 14 cases of De Quervain's stenosing tenosynovitis whose onset of the symptoms ranged 3-24 months before the US exam. The patients were subdivided into three groups, according to disease stage and US patterns; 5 patients were in group 1, six in group 2 and 3 in group 3. The most frequent US findings were: thickening of the tendons, which appeared as separate structures or as a single structure (pseudofusion); diffuse or, in most cases, focal thickening of the sheaths; changes in tendon echogenicity; impaired tendon sliding, which was reduced or absent due to fibrous adhesions and compression by the sheaths. Diffuse tendon and sheath thickening was prevalent in group 1, where the onset of symptoms ranged 3-10 months earlier. Focal sheath thickening and tendon pseudofusion were prevalent in group 2, where the onset of symptoms ranged 8-15 months earlier. Tendon degeneration and fibrous adhesions between tendons and sheaths, as well as the US changes observed in group 2, were found in group 3 where the onset of symptoms ranged 18-24 months earlier. These US changes were not influenced by medical therapy, with the exception of local injections of corticosteroids. To conclude, we propose a classification of De Quervain's syndrome into three stages, according to the US signs characterizing the different stages of disease evolution and the time of onset of the symptoms.

Adult↗
PubMed1997

Osteomyelitis and tenosynovitis due to Mycobacterium marinum in a fish dealer.

Osteomyelitis caused by nontuberculous mycobacteria is rarely reported. We describe a case of tenosynovitis and osteomyelitis of the right middle finger and metacarpal bone caused by Mycobacterium marinum in a fish dealer. This 52-year-old woman suffered progressive pain, numbness, tenderness, and erythematous swelling of the right middle finger over a 2-month period. A radiograph of the right hand disclosed osteolytic lesions at the third metacarpal bone and the third proximal phalanx. She was treated successfully with repeated surgical debridement and antimicrobial agents, including clarithromycin, ethambutol, rifampin, and doxycycline for 1 month, followed by ethambutol and clarithromycin. Pathologic examination of the debrided tissue disclosed epithelioid granuloma, caseous necrosis, and numerous acid-fast bacilli, which were later identified as M. marinum using conventional biochemical tests and by the characteristic gas-liquid chromatogram of esterified cellular fatty acid. The wound healed completely after 7 months of treatment. The patient is still under treatment, and clarithromycin and ethambutol will be given for a total of 18 months.

Animals↗
PubMedDate not supplied

Tuberculous tenosynovitis: a rare manifestation of a common disease.

Two cases of tuberculous tenosynovitis of the hand are presented. The clinical features were those of a gradually enlarging swelling and mild pain over several months. Diagnosis was not initially suspected in either patient, reflecting decreased awareness of this uncommon condition. Both patients had concomitant active pulmonary tuberculosis which was quiescent in the second patient. Combined surgical debridement and antituberculous drugs led to a successful outcome. The condition is discussed and pertinent literature is reviewed.

Adult↗
PubMed1998

Injection therapy for management of stenosing tenosynovitis (de Quervain's disease) of the wrist.

Stenosing tenosynovitis of the first dorsal compartment of the wrist (de Quervain's disease) is a common cause of radial wrist and hand pain and disability. Nonoperative management of the disease has been thought to provide only temporary relief of pain and swelling, while surgical intervention has been viewed as a more definitive treatment. This retrospective study examines the results of 58 patients who presented with de Quervain's disease from January 1993 through December 1995 and were initially treated with a combination steroid/lidocaine injection. After 1 to 3 years of follow-up, 35 patients had complete relief of symptoms with a single injection, 14 had relief of symptoms with two injections, 2 are still under observation, and 7 patients had to undergo operative management. These results indicate that in most patients with de Quervain's disease, treatment with a steroid/lidocaine injection can provide complete relief of symptoms.

Adolescent↗
PubMed1995

Treatment and outcome of chronic tenosynovitis in three horses.

Three horses were presented for treatment of chronic infections of the digital flexor tendon sheath. Clinical signs included severe lameness, and heat, pain and swelling of the digital flexor tendon sheath. The horses were treated with surgical lavage of the tendon sheath, systemic and local antibiotics, and analgesics. In each case, resolution of the lameness occurred over weeks to months. Only one horse returned to athletic activity, while the other two became comfortable at pasture. Response to treatment in cases of chronic tenosynovitis may not be as rapid or complete as that reported for acute tendon sheath infections.

Journal Article↗
PubMed2002

Mycobacterium marinum tenosynovitis in a patient on etanercept therapy for rheumatoid arthritis.

Opportunistic infections are a theoretical concern with the use of tumor necrosis factor antagonists, as these agents can impair host immunity. A 61-year-old man with rheumatoid arthritis being treated with only etanercept (soluble tumor necrosis factor receptor) and in remission from the rheumatoid arthritis presented with dorsal tenosynovitis of his right wrist. The synovitis was not improved by a local corticosteroid injection. Surgical exploration showed granulomatous inflammation, and cultures were positive for Mycobacterium marinum infection. Etanercept was discontinued 4 months after the hand infection started. The infection resolved completely with surgery and antibiotic therapy with clarithromycin 500 mg twice daily orally for 3 months. Although M. marinum infection was locally invasive, there was no systemic dissemination of the infection despite ongoing etanercept therapy for 4 months before it was discontinued. With more frequent use of this class of agents for rheumatoid arthritis and Crohn's disease, we caution physicians to be alert for the possibility of this kind of local opportunistic infection.

Journal Article↗
PubMed2004

Histoplasmosis with tenosynovitis of the hand and hypercalcemia mimicking sarcoidosis.

We report on an otherwise healthy 47-year-old male who developed subacute tenosynovitis of the hand associated with night sweats and inguinal lymphadenopathy. He had a past history of granulomatous mediastinal lymphadenitis with positive histoplasmosis serology 11 years previously. Carpal tunnel exploration with biopsy demonstrated granulomatous inflammation. Granulomatous inflammation, hypercalcemia, and an elevated serum angiotensin converting enzyme (ACE) level suggested the diagnosis of sarcoidosis, however histoplasmosis infection could eventually be diagnosed. This unusual presentation of histoplasmosis underscores the fact that the diagnosis of sarcoidosis requires careful exclusion of other causes of granulomatous inflammation, particularly infectious agents. Even in the setting of an elevated ACE level and hypercalcemia, the possibility of an infectious etiology must be considered before establishing a diagnosis of sarcoidosis.

Journal Article↗
PubMed1978

Pigmented villonodular tenosynovitis: a case report.

A case of pigmented villonodular tenosynovitis is described. The characteristics and clinical course are discussed and compared as to natural history, histopathology, pathophysiology, etiology, differential diagnosis, and treatment. The etiological factors of this entity are generally uncertain; however, this case may well be associated with a specific incident of trauma, eg., a puncture wound sustained from stepping on a nail.

Adolescent↗
PubMed1994

Cytogenetic characterization of tenosynovial giant cell tumors (nodular tenosynovitis).

Chromosome investigation in six localized forms of tenosynovial giant cell tumors, also known as modular tenosynovitis, revealed an identical translocation between chromosomes 1 and 2, t(1;2)(p11;q35-36) in three tumors, a variant translocation t(1;5)(p11;q22) in a fourth case, and a t(2;16)(q33;q24) in a fifth case. One case showed a normal karyotype. Although morphologically rather uniform, these benign tumors appear to be cytogenetically heterogeneous, but the chromosome changes seem to cluster in 2 regions, 1p11 and 16q24.

Adult↗