Presentation
A case is presented where flexor tenosynovitis of the volar wrist is the presenting symptom of sarcoidosis in a 69-year-old man. [ncbi.nlm.nih.gov]
Entire Body System
- Weakness
He will check to see if you have any pain, weakness, or movement problems. He may also check your other upper extremity for any pain, weakness, or movement problems. [drugs.com]
The possibility of tuberculous tenosynovitis should be considered for an insidious hand weakness that occurs in the absence of external injuries. [medcraveonline.com]
You have tingling, weakness, or numbness in your hand and fingers. Your pain gets worse. The tendon may be infected. Signs of infection include: Increased pain and tenderness around the wrist or thumb. Swelling or redness of the wrist or thumb. [myhealth.alberta.ca]
It's a powerful treatment option, but too many injections can make the tendons weak over time. Medication: Your doctor may recommend non-steroidal anti-inflammatory drugs to control pain and inflammation. [orthoarlington.com]
Compression will cause ischemia resulting in numbness and tingling in this distribution. [6] C6 Cervical Radiculopathy Compression on a spinal nerve root can cause sensory disturbances, myotomal weakness, and diminished reflexes throughout the root's [physio-pedia.com]
- Surgical Procedure
The outpatient surgical procedure involves opening or cutting the inflamed part of the tendon sheath to relieve the pressure on the tendon and allow free movement of the wrist. [newwestsportsmedicine.com]
If the problem persists, a surgical procedure to create more room for the tendons can be performed. During this surgical procedure, the tight tissue around the tendons is cut to release the restriction on tendon motion. [verywell.com]
If a surgical procedure is indicated to treat the condition, patients can be referred to an orthopedic surgeon who specializes in the upper extremities. [sports-health.com]
Surgical Procedure If conservative treatment options fail to resolve the condition and symptoms persist for 6 months or more and your quality of life is adversely affected, your surgeon may recommend you undergo a surgical procedure to open the tendon [handsurgery.com.au]
- Severe Pain
It is vital to reduce the acute inflammation that is causing all the severe pain. Learn How To Reduce Inflammation. [tendonitisexpert.com]
The four classic clinical signs of Infectious tenosynovitis described by Kanavel are: (1) tenderness to palpation, (2) fusiform swelling of the digit, (3) flexed resting position of the involved finger, and (4) severe pain with passive extension 17. [radsource.us]
Respiratoric
- Aspiration
The diagnosis was confirmed by fine needle aspiration biopsy. A satisfactory resolution was obtained by antibiotic therapy alone, indicating that radical synovectomy may not be necessary in all cases of M. malmoense infection. [ncbi.nlm.nih.gov]
A diagnosis of ganglion was established on fine needle aspiration cytology. Findings on chest X-rays were normal. Right wrist joint X-ray showed no significant findings. [jmedicalcasereports.biomedcentral.com]
Although direct aspiration and injection of corticosteroids with lidocaine can be performed, this is seldom needed. Follow-up radiographs will generally show complete disappearance of small deposits in 2 to 4 weeks. [musculoskeletalkey.com]
Skin
- Erythema
Erythema [redness], tenderness, and painful range of motion of the involved tendon are present. Hemorrhagic macules or papules may be present in a gonococcal infection. [boneandspine.com]
Initial signs of flexor tendon involvement include marked pain, erythema, acute swelling, and warmth suggestive of acute suppurative tenosynovitis. [musculoskeletalkey.com]
[…] flexor tendon sheath infection, which are as follows: Finger held in slight flexion Fusiform swelling Tenderness along the flexor tendon sheath Pain with passive extension of the digit Clinical features of gonococcal tenosynovitis include the following: Erythema [emedicine.medscape.com]
Physical exam findings vary based on cause and extent; however, in general, they demonstrate swelling, pain, erythema, and difficulty moving the affected joint. [ncbi.nlm.nih.gov]
Musculoskeletal
- Tendon Disorder
The most common sites for tendon disorders are (Figure 3): Figure 3 Shoulder Bicipital tendinopathy - disorder of the tendon to the biceps. [ccohs.ca]
- Osteoporosis
Radiographic features of tuberculous infection of the wrist include bone erosion or cavitation, localized osteoporosis, gross destruction, and eventually joint ankylosis [ 6 ]. [omicsonline.org]
Neurologic
- Confusion
Do not confuse this disease with a sprain, which occurs when any injuries. The inflammatory process may provoke several sports such as volleyball, jumping, running. [medicalj-center.info]
If there is still confusion about the diagnosis, an MRI test may be helpful. Typically the tendons within the first dorsal compartment will look thickened, and often there will be some swelling around the tendons. [verywell.com]
[…] that corticosteroid injection was the first line of treatment and surgery should be reserved for unsuccessful injections. [25] Eponym [ edit ] It is named after the Swiss surgeon Fritz de Quervain who first identified it in 1895. [26] It should not be confused [en.wikipedia.org]
The diagnosis is frequently delayed, presumably because of confusion with infection. [musculoskeletalkey.com]
- Paresthesia
On the flexor surface, the earliest signs of considerable flexor tenosynovitis may be painful paresthesias caused by median nerve entrapment beneath the unyielding transverse carpal ligament. [musculoskeletalkey.com]
CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. [13] Other possible findings include weakness and paresthesia [physio-pedia.com]
- Numbness of the Hand
Call your doctor or nurse call line now or seek immediate medical care if: Your hand or fingers are cool or pale or change colours. You have tingling, weakness, or numbness in your hand and fingers. Your pain gets worse. The tendon may be infected. [myhealth.alberta.ca]
Workup
Imaging Obtain standard anteroposterior and lateral radiographs to rule out bony involvement or a foreign body. [1] See Workup for more detail. [emedicine.medscape.com]
Treatment
RESULTS: Scores for tenosynovitis showed a significant reduction in the etanercept group compared with placebo (p=0.01) after 6 weeks of treatment. [ncbi.nlm.nih.gov]
Treatment of De Quervain’s Tenosynovitis Like most conditions of a similar nature, the earlier a diagnosis is made and treatment can begin the faster the recovery time. [osmifw.com]
Diagnosis and treatment of disease At the first symptoms of inflammation of the tendon is necessary to see a doctor. That the treatment was successful, you will need to implement all the recommendations of doctors. [medicalj-center.info]
Prognosis
What is the prognosis with de Quervain's tenosynovitis? The prognosis for de Quervain's tenosynovitis is excellent. The patient can generally return to full function after the inflammation quiets down with treatment. [medicinenet.com]
Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Am. 2007 Aug;89(8):1742-8. [PubMed: 17671013] 13. Kennedy CD, Lauder AS, Pribaz JR, Kennedy SA. [ncbi.nlm.nih.gov]
Prognosis: Most patients recover well from tenosynovitis with rest and treatment. Recurrence: If a person has had tenosynovitis once, it’s likely to recur, especially if the cause is not addressed. [practo.com]
MRI Increased fluid within tendon sheath: T1: low or intermediate if debris within tendon sheath T2: high T1 C+ (Gd): tendon sheath thickening and peritendinous subcutaneous contrast enhancement Treatment and prognosis Treatments may include non-steroidal [radiopaedia.org]
Etiology
Contrast should be a consideration in cases concerning for infectious etiologies for abscess visualization. [ncbi.nlm.nih.gov]
The synovial membrane is part of a fluid-filled sheath that surrounds a tendon. joint swelling pain in the affected area and pain moving a joint reddening along the length of the affected tendon difficulty moving the joint Etiology Tenosynovitis can be [radiopaedia.org]
(See Pathophysiology and Etiology.) Much of the original work on infectious FT was done by Kanavel. [emedicine.medscape.com]
Infecting organisms include the following Staphylococcus aureus and Streptococcus [most common etiologic agents], Pasteurella multocida [mostly after a cat bite], Eikenella corrodens, anaerobes, Capnocytophaga canimorsus [ dog bites], Mycobacterium [bacteriae [boneandspine.com]
Eight weeks later, after initial improvement, hand swelling and pain increased, accompanied by spontaneous drainage of cold abscesses on wrist, elbow, and knee, without evidence of an alternative etiology. [academic.oup.com]
Epidemiology
OBJECTIVE: To explore the possible role of ultrasonography in case definitions for epidemiological studies of work-related wrist tenosynovitis. [ncbi.nlm.nih.gov]
[…] pollicis longus (APL) origin: dorsal side of the radius and the ulna, the membrana interossea insertion: base of ossis metacarpi I function: - wrist joint: radial abduction - thumb: abduction innervations: N. radialis artery: A. interossea posterior Epidemiology [physio-pedia.com]
The ultimate consequences are tendon necrosis, disruption of the tendon sheath, and digital contracture. [18, 19] Epidemiology Infectious flexor tenosynovitis No data exist regarding the incidence of infectious FT. [emedicine.medscape.com]
Causative Factors Although the cause of tendon entrapment is disputed, certain epidemiologic factors are apparent. [musculoskeletalkey.com]
Pathophysiology
A basic understanding of the tendon anatomy allows the clinician to appreciate the pathophysiology, treatment, and complications. The tendon anatomy and relationship to the tendon sheath are well illustrated in the hand. [ncbi.nlm.nih.gov]
(See Pathophysiology and Etiology.) Much of the original work on infectious FT was done by Kanavel. [emedicine.medscape.com]
[…] piano-playing, sewing, and knitting. [7] Women are affected more often than men. [7] The syndrome commonly occurs during and after pregnancy. [11] Contributory factors may include hormonal changes, fluid retention and—more debatably—lifting. [11] [12] Pathophysiology [en.wikipedia.org]
Prevention
However, in developing countries like Ghana where tuberculosis is prevalent, it should be part of the differential diagnosis of compound palmar ganglion in order to prevent delayed diagnosis and treatment. [ncbi.nlm.nih.gov]
Preventing de Quervain’s The following are ways to prevent de Quervain’s: • Avoid repetitive motions such as those performed during prolonged gardening, especially weeding and pruning. • Do not perform constant motions such as chopping, sawing, knitting [westchestermagazine.com]
Tendon sheath inflammation is preventable if you avoid excessive movements or motions that are repetitive or forceful. [healthline.com]
In tenosynovitis, inflammation of the tendon sheath prevents this free movement, but any attempted movement tends to be painful and limited. [practo.com]
Prevention of tenosynovitis is regular exercise. It is very important that the weight is evenly distributed and affect different muscle groups. [medicalj-center.info]