Tenosynovitis of the wrist. A sonographic demonstration.
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A 60-year-old man who had been suffering from psoriasis for 20 years developed finger dactylitis and inflammatory swelling with pitting edema over the dorsum of the hand one week after a contusive trauma to the left hand. These were not followed by any other clinical manifestations of PsA.
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A 56-year-old man presented with a mass of the right wrist limiting excursion of the digits. Operative exploration demonstrated gouty infiltration of the flexor tendons. The tendons were debrided of the urate crystalline material and the motion of the digits returned, preserving all tendon function. The patient later returned with symptoms of carpal tunnel in the contralateral wrist. Exploration of the carpal tunnel revealed similar infiltration of the flexor tendons. The tendons were debrided and the carpal tunnel syndrome resolved.
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Rupture of the extensor pollicis longus (EPL) tendon after a distal radius fracture is an uncommon event; the incidence is 3%,according to a review of treatment of 200 consecutive patients with Colles fractures. Diagnosis is based on persistent dorsal wrist pain and a positive retroflexion sign. Recommended treatments in the prerupture setting include a third dorsal compartment release with or without an extensor retinacular patch graft. Also recommended are a palmaris longus graft in the acute rupture setting and a transfer from the extensor indicis proprius to the EPL tendon in the subacute or chronic setting. Results of all treatments seem to be clinically satisfactory.