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PubMed1987

Bacterial flexor tenosynovitis in the hand. A series of 68 cases.

The authors report 68 cases of bacterial tenosynovitis (BT) that is the largest international series dealing with this pathology since the introduction of antibiotics. Their study stresses the connection between the quality of the final result and the stage at which the condition is treated. The speed at which the tenosynovitis becomes established depends on the mechanism of infection. One can dissociate BT by direct inoculation with violation of the tenosynovial sheath, from the BT by diffusion through an undamaged sheath. The former progress within a few hours to a few days, the latter slowly in a few days to a few weeks, with a slower onset masked by the clinical signs of the initial infection. They propose a new classification which allows the choice of proper surgical therapy taking into account the type of onset of the BT and the intraoperative findings.

Adult↗
PubMed2005

[Mycobacterium marinum tenosynovitis of the abductors].

INTRODUCTION: Infection with Mycobacterium marinum is rare and usually produces cutaneous lesions. We report here two cases of tenosynovitis of abductor muscles. CASE: The first case presented isolated involvement of the abductors of the left thumb, and the second the abductors of the middle finger. In both cases, the bacteriological examinations found M. marinum. Antibiotic therapy for three months with rifampin and clarithromycin cured the infection. DISCUSSION: These cases of tenosynovitis followed deep inoculation. A mycobacterial infection should be considered in cases of synovitis, especially when limited to an area of the hand in patients without other rheumatic disorders.

Anti-Bacterial Agents↗
PubMedDate not supplied

The role of endoscopy in treatment of stenosing posterior tibial tenosynovitis.

Some foot and ankle pathologic conditions can be treated by an endoscopic approach. Its effectiveness has been reported in the treatment of plantar fasciitis. The authors have used an endoscopic approach in the treatment of posterior tibial tenosynovitis resistant to nonsurgical treatment. A review of the pathology, terminology and the diagnosis of tenosynovitis is provided. The case report demonstrates a technique using an endoscope to incise the posterior tibial tendon sheath.

Adult↗
PubMed2001

Tenosynovitis of the posterior tibial tendon.

PTT tenosynovitis is a recognized entity no longer confused with an ankle sprain. Three possible causes are (1) overuse or age related (mechanical in cause, true stage I disease), (2) seronegative spondyloarthropathies (clinical suspicion, hematologic analysis), and (3) rheumatoid arthritis (deformity may be owing to ligamentous or capsular destruction). The PTT has a hypovascular zone 40 mm proximal to the insertion of the tendon and 14 mm in length. Pain often is localized to this portion of the tendon (primarily in stage I disease). Ultrasound is an inexpensive and accurate method to assist in the diagnosis of this condition and may replace MR imaging as more experienced ultrasonographers appear. The initial management of PTT tenosynovitis includes tendon rest and nonsteroidal anti-inflammatory medication and physical therapy. Surgical synovial débridement is performed early (6 weeks) in patients with enthesopathies (seronegative disease). This procedure may be delayed 3 months in patients with true stage I disease. At surgery, the undersurface of the tendon must be inspected for longitudinal split tears, and these must be repaired with nonabsorbable suture, burying the knots. The excursion of the tendon should be checked intraoperatively. Patients with stage I disease should be evaluated carefully for preoperative structural deformity to choose the appropriate surgical procedure and prevent failure of isolated tenosynovectomy.

Ankle↗
PubMed1999

Sesamoiditis of the index finger presenting as acute suppurative flexor tenosynovitis.

Sesamoiditis involving the hand is uncommon, usually reported in the thumb, and has not been reported in the index finger. As rare as this clinical entity remains, its presentation simulating an acute suppurative flexor tenosynovitis is even more rare. We report a patient who presented with Kanavel's 4 cardinal signs of acute suppurative tenosynovitis who was subsequently found to have an acute sesamoiditis of the index finger. This finding was supplemented by a cadaveric and radiographic study to better delineate the anatomy of the index sesamoid and further explain the clinical presentation.

Acute Disease↗
PubMed1995

What do doctors mean by tenosynovitis and repetitive strain injury?

Confusion exists in both the scientific and the lay press on the meaning of the terms tenosynovitis and repetitive strain injury. The courts are increasingly being asked to make judgements on individual cases but this gives little in the way of guidance to doctors producing reports for the Department of Social Security or solicitors. The aim of this study was to document what such doctors mean by these terms, what diagnostic criteria they use, and to make any necessary recommendations. The diagnostic criteria for DSS industrial conditions A8 (tenosynovitis) and A4 (professional cramp) varied greatly and what the experts understood by the term 'repetitive strain injury (RSI)' was so variable that the term is meaningless. Half of the doctors who responded felt that there was no genuine organic condition corresponding to their assessment of what the term means. As half of the doctors providing reports believe that 'repetitive strain injury' is not a genuine disease entity and the other half do, court cases will continue. The dilemma appears to be that completely different meanings are ascribed to the same term. Therefore, the term 'repetitive strain injury' should no longer be used.

Cumulative Trauma Disorders↗
PubMed2006

Compensating occupationally related tenosynovitis and epicondylitis: a literature review.

OBJECTIVES: To assess occupational associations with tenosynovitis and epicondylitis, we conducted a systematic literature review. We focused particularly on evidence that might support compensation of these disorders 'on the balance of probabilities'. METHODS: We searched the MEDLINE and EMBASE electronic biomedical databases to 1 January 2005 using combinations of keyword and medical subject headings, and also the references cited in two state-of-the-art reviews from the 1990s. Primary research reports were retrieved and checked for further relevant citations. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect. RESULTS: We found and summarized 18 papers. In the main, these based analysis on job titles rather than on directly assessed physical activities. Few occupations were studied more than once, however, and there was little consistent evidence of jobs or work activities that carried more than a doubling of risk for either disorder. CONCLUSION: Compensation of occupational illness can be problematic for disorders that are not specific to work and for which there are no distinctive clinical features in occupationally related cases. Attribution can, however, be made on the balance of probabilities if there is convincing evidence that risk is at least doubled in an occupational group. Our review highlights the relative lack of data to support such attribution for tenosynovitis and epicondylitis, and discusses the difficulty of compensating upper limb disorders.

Humans↗
PubMed1995

Stenosing tenosynovitis of the extensor carpi ulnaris.

Despite the paucity of reports in the literature, we have found extensor carpi ulnaris tenosynovitis to be relatively common in our practice. A retrospective review of charts revealed 15 patients treated over the last 4 years. Follow-up ranged from 10 to 14 months. All patients had ulnar-sided wrist pain and underwent conservative treatment consisting of splinting and steroid injection. In 7 of the 15 initial treatment failed and surgical release was required. Of these, 3 exhibited partially ruptured tendons from exposed bone and underwent reconstruction of the floor of the compartment. Preoperative x-ray films were helpful in identifying those with bone involvement. All but one patient had a good or excellent result. Stenosing tenosynovitis of the extensor carpi ulnaris may be more common than reported, and early intervention may prevent tendon damage in some patients.

Constriction, Pathologic↗
PubMed1999

Flexor tenosynovitis in the hand caused by Mycobacterium terrae.

The authors describe an uncommon case of flexor tenosynovitis caused by Mycobacterium terrae, an atypical mycobacterium generally considered nonpathogenic in humans. A prolonged delay in diagnosis and various ineffective therapies led to synovial biopsy and culture. After confirming the diagnosis of M. terrae, appropriate antimycobacterial chemotherapy resolved the synovitis. For chronic tenosynovitis without a clear etiology, limited synovectomy and culture are essential in establishing a diagnosis and in initiating treatment for this atypical mycobacterial infection.

Adult↗
PubMed1979

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↗
PubMed1993

Echinoidea tenosynovitis.

Suppurative tenosynovitis involving the digital fibrous flexor sheaths in the hand can be a devastating problem. A case is reported of tenosynovitis resulting from Echinoidea sp. (sea urchin) spines. The need for awareness of flexor sheath penetration is stressed. Early aggressive operative intervention by a hand surgeon will minimize the subsequent morbidity.

Adult↗
PubMedDate not supplied

Tenoscopic examination and proximal annular ligament desmotomy for treatment of equine "complex" digital sheath tenosynovitis.

OBJECTIVE: To determine the outcome of horses with "complex" digital tenosynovitis treated by tenoscopic proximal annular ligament desmotomy and resection of synovial masses or adhesions, or both, within the digital sheath. STUDY DESIGN: Retrospective evaluation. ANIMALS OR SAMPLE POPULATION: Twenty-five horses with a clinical and ultrasonographic diagnosis of palmar or plantar proximal annular ligament constriction and ultrasonographic evidence of synovial masses or adhesions within the digital tendon sheath. METHODS: Each horse had tenoscopic surgery for annular ligament desmotomy combined with adhesiolysis and/or synovial mass resection. Mean follow-up time was 3.4 years. Spearman's rank correlation was used to assess the relationship between functional outcome or cosmetic results and preoperative variables including duration of clinical signs, digital sheath synovial fluid total protein concentration and nucleated cell count, thickness of the palmar or plantar proximal annular ligament (PAL), severity of adhesions, severity of synovial masses, degree of synovial distention, or limb affected. RESULTS: A total of 18 (72%) horses returned to athletic soundness, 4 were improved but not sound, and 3 were not improved. Cosmetic outcome was normal in 10 horses, improved but not normal in 12, and not improved in 3 horses. Cosmetic and functional outcome were significantly adversely affected by the duration of clinical signs and the severity of synovial masses. CONCLUSIONS: With appropriate tenoscopic surgical attention, horses with complex tenosynovitis syndrome characterized by synovial masses, adhesions, or both adhesions and masses, and PAL constriction, have a good prognosis for return to athletic soundness. CLINICAL RELEVANCE: Horses with PAL constriction and additional digital tendon sheath pathology such as adhesions and synovial masses have a 72% chance of returning to sound athletic performance, however 60% of horses retain some degree of cosmetic blemish in the affected limb. There is an inverse relationship between the duration of clinical signs and outcome, and therefore, prompt surgical attention is advised.

Animals↗
PubMedDate not supplied

Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses.

OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven client-owned horses. METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful. Time from initial injury to complete resection was 1-22 weeks. In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1). In 1 horse, the surgical wound healed by second intention. All horses had postoperative bandaging, antibiotic administration, and physiotherapy. RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse. Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality. CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis. CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection.

Animals↗
PubMed2004

Glenoid dysplasia and bicipital tenosynovitis in a Maine coon cat.

This report describes a rare case of bicipital tenosynovitis in a Maine coon cat. The cat, a three-and-half-year-old neutered female, presented with chronic weightbearing lameness of the left forelimb. Flexion of the left glenohumeral joint and extension of the left cubital joint were resented, and palpation of the biceps brachii tendon in the bicipital groove elicited pain. A mild incongruity of the joint with mild degenerative changes was seen radiographically. Glenohumeral joint dysplasia was suspected. Ultrasound examination revealed marked thickening of the bicipital tendon and moderate effusion of the left bicipital tendon sheath. Positive contrast radiography of the joint confirmed dilation of the tendon sheath. A tentative diagnosis of bicipital tenosynovitis was made and confirmed on arthrotomy. Surgical removal of osteophytes resulted in the cat being free from pain but a mild lameness recurred six months after surgery.

Animals↗
PubMed1999

Tenosynovitis associated with longitudinal tears of the digital flexor tendons in horses: a report of 20 cases.

The paper describes a series of cases with longitudinal tears in the superficial or deep digital flexor tendons within the digital flexor tendon sheath. This appears to be a previously unreported condition. Twenty cases are described, one horse was affected bilaterally. Nineteen defects involved the deep digital flexor tendon and in 2 horses the manica flexoria of the superficial digital flexor tendon was torn. All affected horses were lame and there was marked distension of the digital flexor tendon sheaths. Ultrasonography revealed nonspecific signs of chronic tenosynovitis but not the cause. Diagnosis was established by tenoscopy in 9 cases and by open surgical exploration in the remainder. In 7 limbs, the deep digital flexor tendon lesions were treated by removal of the torn fibrils under tenoscopic control. In the remaining cases they were removed and the defects were repaired with absorbable suture material. Wound closure in all open cases included repair of the palmar/plantar annular ligament. Eleven horses became sound and returned to work, 3 improved but were lame on returning to work and 2 horses did not improve following treatment. At the time of reporting, 4 horses are sound and in controlled ascending exercise regimes. It is concluded that longitudinal tears of the digital flexor tendons should be considered in the differential diagnosis of tenosynovitis of the digital flexor tendon sheath. The results presented suggest that accurate diagnosis and specific treatment justify surgical investigation.

Animals↗
PubMed2005

Tenosynovitis of the wrist due to resistant Mycobacterium tuberculosis in a heart transplant patient.

Tubercular tenosynovitis is now rare, which can delay diagnosis of this disease. We report a case of tenosynovitis of the wrist in a heart transplant patient caused by an isoniazid- and streptomycin-resistant Mycobacterium tuberculosis strain. Despite immunosuppression therapy, which can lead to a smoldering evolution, molecular biology analysis of biopsies allowed a rapid diagnosis.

Anti-Bacterial Agents↗
PubMed1981

Peroneus longus tenosynovitis.

Tenosynovitis of the tendon of peroneus longus has rarely been described in the literature (Aberle-Horstenegg, 1932; Burman and Lapidus, 1931). This is a report on the condition in two athletes and in one of whom the os peroneum was absent on the side of the tenosynovitis. It emphasises the importance of a detailed review of athletes' training patterns when assessing their injuries.

Adult↗