[Operative therapy for rheumatoid arthritis of the hand]. / Operative Therapie bei rheumatoider Arthritis der Hand.

The need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient's hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.

Minimally invasive endoscopic management of tubercular tenosynovitis of the anterior tibial tendon.

The incidence of tubercular tenosynovitis around the foot and ankle is rare even in endemic areas. We present an unusual case involving the isolated tubercular tenosynovitis of the Anterior Tibial tendon, which was successfully managed through a combination of medical treatment and endoscopic intervention. Our patient, a 30-year-old female, sought medical attention due to a gradually worsening painful swelling localized to the anterior aspect of her left ankle. Diagnostic imaging, specifically Magnetic Resonance Imaging (MRI), revealed alterations in signal intensity within the Anterior Tibial tendon. Importantly, the infection had not spread to involve the ankle joint. We performed both diagnostic and therapeutic tenosynovectomy endoscopically and subsequently sent the tissue for histopathological examination. The histopathological findings revealed the presence of histiocytic granulomas containing Langhans' giant cells, which strongly suggested a tuberculosis infection. Consequently, we initiated anti-tubercular chemotherapy as the treatment approach. Our patient exhibited a positive response to the treatment, and after one year, she experienced complete resolution of the disease. This case underscores the importance of maintaining a high level of clinical suspicion for tuberculosis, especially in endemic areas, when encountering unusual presentations. Level of evidence: V.

Flexor Tenosynovectomy for Recurrent Carpal Tunnel Syndrome: A Retrospective Case Series of 108 Hands.

Background: The etiology of recurrent carpal tunnel syndrome (CTS) is unclear, and outcomes following secondary surgery in this demographic have been poorer than primary surgery. Fibrosis and hypertrophy have been identified in the flexor tenosynovium in these patients. The authors use flexor tenosynovectomy (FTS) for recurrent CTS after primary carpal tunnel release and present a review of these patients. Methods: A retrospective chart review was performed of 108 cases of FTS for recurrent CTS from 1995 to 2015 by 4 attending surgeons at one institution. Demographic information, symptoms, and outcomes were among the data recorded. A phone survey was conducted on available patients where the shortened version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and satisfaction were assessed. Results: Average office follow-up was 12 months. Average age was 57.5 years. A total of 104 (96%) reported symptom improvement and 48 (44%) reported complete symptom resolution. Forty patients were available for long-term follow-up at an average 6.75 years postoperatively via phone interview. Average QuickDASH score was 31.2 in these patients. Thirty-six (90%) of 40 patients were initially satisfied at last office visit, and 31 (78%) of 40 were satisfied at average 6.9 years, a maintenance of satisfaction of 86%. Satisfied patients were older (58 years) than unsatisfied patients (51 years). Conclusion: Both long-term satisfaction and QuickDASH scores in our cohort are consistent with or better than published results from nerve-shielding procedures. The authors believe a decrease in both carpal tunnel volume and potential adhesions of fibrotic or inflammatory synovium contributes to the benefits of this procedure. This remains our procedure of choice for recurrent CTS.

Clinical Study on the Treatment of Moderate to Severe Stenosing Tenosynovitis of the Flexor Digitorum Tendon with 45° Arc Edge Needle Incision and Traditional Needle Knife Release Surgery / 世界科学技术-中医药现代化

Objective To study the safety and effectiveness of arc edge needle therapy for moderate to severe tenosynovitis of the flexor digitorum tendon in the thumb.Methods A total of 62 patients with moderate to severe stenosing tenosynovitis of the flexor digitorum thumb who met the inclusion criteria were collected.The patients were randomly assigned 1:1 to the arc edge needle group and the needle knife group using a random number table method.Among them,31 patients in the arc edge needle group were treated with arc edge needles,while 31 patients in the needle knife group were treated with traditional needle knife release surgery.Both groups were treated once.Record the number rating scale(NRS),range of motion(ROM),Quinell grade,and disease efficacy score(WDES)of patients before and after treatment at various stages(1 week,2 weeks,4 weeks),and at follow-up after 24 weeks to evaluate the treatment effect.Results During the 24 weeks follow-up of 62 patients after treatment,the Quinell grading comparison between the two groups showed that the arc edge needle group was better than the needle knife group(P<0.05);The total effective rate of disease efficacy score(WDES)was 96.77%in the arc edge needle group and 83.87%in the needle knife group.The clinical total effective rate of the arc edge needle group was better than that of the needle knife group(P<0.05);After treatment,both groups showed significant improvement in pain numerical score(NRS)and joint range of motion(ROM),and the degree of improvement increased over time(P<0.05);And the inter group comparison at 1 week,2 weeks,4 weeks and 24 weeks time points after treatment showed that the curved blade needle was superior to the needle knife group in improving pain and joint mobility(P<0.05).Conclusion Both the 45° tenosynovitis incision and release surgery with arc edge needle and traditional needle knife release surgery are effective in treating moderate to severe tenosynovitis of the thumb flexor digitorum tendon.However,the 45° tenosynovitis incision and release surgery with arc edge needle has significant advantages in improving pain,interphalangeal joint mobility,and safety.

Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion.

OBJECTIVE: The objective of this study was to examine the clinical and magnetic resonance imaging (MRI) outcomes of extensive tenosynovectomy on patients with diffuse flexor hallucis longus tenosynovitis combined with effusion (DFHLT-E). METHODS: Consecutive patients undergoing extensive tenosynovectomy for DFHLT-E in the same foot and ankle center from January 2013 to December 2016 were selected; a total of 14 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, MRI, American Orthopaedic Foot and Ankle Society (AOFAS) clinical midfoot scale, and visual analog scale (VAS) pain scores. RESULTS: The 14 patients were followed up for an average of 15.0 ± 2.3 months (12-18 months). There were no recurrences in all clinical examinations at the final follow-up. The AOFAS score was improved from 61.57 ± 10.70 before surgery to 90.28 ± 9.41 at the final follow-up. The difference was statistically significant (p = 0.001). The VAS score was improved from 4.00 ± 0.82 before surgery to 0.43 ± 0.53 at the final follow-up (p < 0.001). MRI examination revealed two patients with small residual and limited effusion with no clinical symptoms. Superficial pin infection was observed in one patient, and two patients had transient neurostimulation. CONCLUSIONS: Extensive tenosynovectomy is an effective alternative for the treatment of DFHLT-E with less complications or recurrence.

Isolated Tuberculous Peroneal Tenosynovitis: A Case Report.

Tuberculosis (TB) of osteoarticular sites constitutes less than 3% of total patients with tuberculosis. Involvement of the foot and ankle is less than 0.3% of total disease. Even in a country like India, where the incidence of TB is not uncommon, we do not encounter isolated tenosynovitis. We present a young man with bilateral tubercular peroneal tenosynovitis who was evaluated with relevant investigations and operated upon and started on antitubercular treatment (ATT) in consultation with the pulmonologist. After tenosynovectomy and commencement of ATT, the patient's symptoms improved.

Bilateral recurrent wrist flexor tenosynovitis and rice body formation in a patient with sero-negative rheumatoid arthritis: A case report and review of literature.

INTRODUCTION: Rice body formation has been traditionally observed in the joint and tendon sheaths of patients with tuberculosis. Few case reports exist that describe rice body formation in patients with rheumatoid arthritis. We describe a case report of bilateral recurrent wrist flexor tenosynovitis with rice body formation in a patient with sero-negative rheumatoid arthritis. PRESENTATION OF CASE: This case report describes a 72 year old lady presenting with severe bilateral, flexor tenosynovitis of the wrists. Ultrasonography revealed significant echogenic fluid on the palmer aspect of wrist joint surrounding flexor tendons with intact neurovascular bundles and no bony erosion. Laboratory tests demonstrated elevated erythrocyte sedimentation rate (50 mm/h) and negative rheumatoid factor. A sequential subtotal flexor tenosynovectomy was carried out with decompression of the carpal tunnel. During the operation, multiple rice bodies among the flexor tendons with adherent synovitis were found. Histology revealed disrupted synovial tissue containing several areas of fibrinoid necrosis, bounded by a layer of vaguely pallisaded histiocytes but no epitheloid granulomata or germinal centre. A revision surgery with debulking of the fibro-osseous canal was undertaken following recurrence. The patient presently has complete resolution of symptoms at one year follow-up. DISCUSSION: The combined clinical, laboratory, ultrasound and histology findings of the patient indicated that the cause of the rice body formation was due to a sero-negative arthritis rather than tuberculosis. CONCLUSION: Rice body formation can be caused by sero-negative arthritis. Bilateral wrist flexor tensosynovitis can recur within five months of a previous synovectomy in a patient with sero-negative arthritis.

Chronic Post-traumatic Inflammatory Tenosynovitis of the Finger Joint

PURPOSE: Chronic inflammatory tenosynovitis (CITS) involving the finger joint after trauma has been rarely reported. This study reports the surgical results of ten patients with CITS. MATERIALS AND METHODS: From March 2007 to June 2009, ten patients with pain, swelling and limitation of motion of the finger were diagnosed as CITS. All patients had a history of direct injury. The operation was performed at a mean of 6.6 months after the onset of symptom. Average range of motion was 54 degrees in five patients with CITS of the metacarpophalangeal joint and was 44 degrees in five patients with that of the proximal interphalangeal joint. The mean follow-up duration was 15 months. Two of ten patints showed the involvement of the bone. Tenosynovectomy was performed and four patients required volar and dorsal double incisions. In cases of the bony invasion, multiple drilling and curettage was done. RESULTS: Postoperatively, all patients showed improvement of pain and swelling and did not show recurrence. The magnetic resonance image was carried out in all patients and showed the inflammatory changes of the tendosynovium and joint capsule. Culture and PCR test for tuberculosis showed negative findings in all cases. However, anti-tuberculosis chemotheraphy for nine months was applied to three patients who showed caseous necrosis or rice body in biopsy. The mean range of motion was 66 degrees in metacarpophalangeal joint and 53 degrees in proximal interphalangeal joint. CONCLUSIONS: Magnetic resonance image appears helpful in the diagnosis and the treatment of CITS which involved the joint of hand and the operative treatment can improve the symptoms and clinical outcomes.