Treating Trigger Finger in Diabetics using Excision of the Ulnar Slip of the Flexor Digitorum Superficialis with or without A1 Pulley Release

The purpose of this study was to evaluate the results of excision of the ulnar slip of the flexor digitorum superficialis tendon, with or without A1 pulley release, for the treatment of trigger finger in diabetic patients. We performed a retrospective review with long-term follow-up examinations. Short-term data was obtained on 18 consecutive patients (37 fingers). Long-term information was collected on 14 of these patients (24 fingers) at an average of 48 months after surgery. Short-term follow-up revealed average proximal interphalangeal joint (PIP) flexion of 81°. One patient had slight residual triggering. At long-term follow-up, 93% of patients were completely or very satisfied with the procedure. Total active finger motion averaged 218°, and PIP extension deficit averaged less than 5°. Pinch strength was equal to the contralateral corresponding finger. There were no significant complications. One finger had minimal residual triggering. In conclusion, this procedure is a safe and effective treatment for the often-difficult problem of stenosing flexor tenosynovitis in the diabetic patient.     

High-frequency ultrasound examination of the wrist and hand

High-frequency ultrasound (US) is an efficient, rapid and inexpensive altenative to magnetic resonance imaging (MRI) for investigation of diseases in the soft tissues of the wrist and hand. US allows detection of foreign bodies and the reliable identification of a variety of traumatic lesions affecting tendons, annular pulleys, ligaments, vessels and nerves. Inflammatory diseases of tendons, including acute and chronic tenosynovitis and some degenerative conditions in the wrist and hand, can also be diagnosed. In entrapment neuropathies, US is able to identify nerve shape changes and possible extrinsic space-occupying lesions that may cause nerve compression within the tunnels. In patients with localized swelling of the hand or wrist, US is able to assess the presence of an expansile lesion and to characterize its nature in most cases. The objective of this article is to review the main findings and the primary indications of US in the investigation of disorders of the hand and wrist. Received: 10 September 1998 Accepted: 24 November 1998     

桡骨茎突狭窄性腱鞘炎的治疗进展

桡骨茎突狭窄性腱鞘炎,是一种常见的慢性运动系统损伤疾病,多引起关节处疼痛并伴活动时加重,对人们的日常生活造成影响。目前针对此病的治疗方法较多且各有疗效,可以分为保守治疗和手术治疗两种。本病的治疗难点在于根治,保守治疗常常能在急性期缓解疼痛,改善腕部功能,但其远期作用甚微,容易复发。手术治疗能够提高本病的治愈率,但作为有创治疗,存在一系列风险,当遇到顽固性桡骨茎突狭窄性腱鞘炎时才建议选用。笔者认为,患者教育为治疗中重要一环,并且对本病进行分级,根据疾病发展的不同情况合理选用多种手法综合治疗本病,能够有效治愈本病。     

Gouty flexor tenosynovitis of the hand mimicking atypical mycobacterial infection

Abstract

A 50-year-old Japanese fish dealer presented with painful and swollen fingers. Infectious flexor tenosynovitis with Mycobacterium marinum was suspected. Range of motion was restored after tenosynovectomy and after ofloxacin and clarithromycin were administered. Two years after the operation, the patient presented again with acute inflammation in the same fingers. Histopathological examination revealed gouty tenosynovitis. The preconception that mycobacterial infection occurs often in fish dealers caused us to miss the correct diagnosis of gouty tenosynovitis.     

Synovial xanthomatosis: are there clues to mechanisms for this rare disease?

Abstract

We report a 64-year-old man with arthritis and nodules to describe that this picture can be caused by normo-lipidemic xanthomas. Light and electron microscopy (EM) plus polymerase chain reaction (PCR) studies were performed for diagnosis and investigation. These showed features typical of xanthomas plus PCR and EM evidence of possible infection with Chlamydia pneumoniae as a pathogenetic mechanism deserving consideration. With such rare diseases, any clues to possible mechanisms seem important to record and thus to encourage future investigations. This uncommon cause of arthritis and nodules had been confused with rheumatoid arthritis by others in this case.     

US guided injections in arthritis

US guided procedures for diagnosis or treatment of different forms of arthritis are becoming more and more important. This review describes general considerations for fluid aspiration, articular or periarticular injections and biopsies by US guidance according to the recent literature. Guidelines regarding instrumentation, different techniques, pre- and postprocedural care as well as complications are outlined and in the second part a more detailed overview of different interventions in joints, tendons and other periarticular regions (nerves, bursae, etc.) is included. Furthermore, some newer, more sophisticated techniques are briefly discussed.     

雌激素水平与绝经后妇女腱鞘炎的相关性研究

目的 探讨雌激素水平与绝经后妇女腱鞘炎的关系.方法 选取74例绝经妇女,其中32例为腱鞘炎患者(A组),42例同期健康体检的绝经妇女为对照组(B组);42例正常行经的健康体检妇女为正常对照组(C组).均进行雌激素水平测定,并进行相关性分析.结果 A组与B组之间,雌激素(E2)水平分别为(89.7066±126.7458)pmol/L和(45.6768±30.6342)pmol/L,差异无统计学意义(P>0.05);A组与C组雌激素水平分别为(89.7066±126.7458)pmol/L和(626.7384±361.5348)pmol/L,差异有统计学意义(P<0.01).结论 绝经后妇女腱鞘炎发病与雌激素水平变化无明显关系.     

de Quervain’s tenosynovitis: a review of the rehabilitative options

de Quervain’s tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. A 34-year-old right hand-dominant female who works in a daycare facility presents with radial side wrist pain during lifting activity for the past 4–6 weeks. The patient was diagnosed with de Quervain’s tenosynovitis and conservative care was initiated. Conservative care involved anti-inflammatory medication and corticosteroid injections as well as occupational therapy to include splinting, activity modification, modalities, manual treatment, and therapeutic exercise. Although conservative care assisted the patient with her symptoms initially, she returned with increased pain and discomfort after 2 months time. At that point, surgery was discussed and performed to release the first dorsal compartment as well as the sub-compartment. The patient was provided with a splint postoperatively and initiated occupational therapy for edema and scar management, therapeutic exercise, and desensitization. Ultimately, the patient was able to return to work pain free.     

Antigen-induced tenosynovitis in hypersensitized rabbits: a model for rheumatoid tenosynovitis

Summary Rabbits were first immunized and later challenged with the same antigen (bovine serum albumin, or ferritin) by injection into the tibialis anterior tendon. Inflammatory changes of the tenosynovium and epitenon included infiltration by neutrophils (early) and mononuclear cells (later) over a 6-week course of tenosynovitis. A pattern of antigen entrapment in the tendon together with immunoglobulin was shown by use of radiolabelled antigen and immunochemical staining. Half-life of antigen in the tissues averaged 5 days over the 6-week period. Changes in the epitenon included cellular necrosis, appearance of phagocytic cells, and disruption of the collagen matrix. Tissues of control animals (challenged without prior immunization) showed minimal changes and significantly less retention of antigen (P>0.005). The model is relevant to the mechanism of tendon damage associated with antigen-driven chronic inflammation, as may be the case in rheumatoid arthritis.     

针刀治疗指屈肌腱腱鞘炎的临床疗效

目的观察针刀治疗指屈肌腱腱鞘炎的临床疗效。方法把指屈肌腱腱鞘炎中后期的患者125例随机分为治疗组64例和对照组61例。对照组采用局部药物封闭治疗,治疗组用针刀松解狭窄的腱鞘。结果治疗21 d后治疗组治愈率(92.18%)、总有效率(96.87%)明显高于对照组(治愈率42.62%、治愈率90.16%)(P0.05)。180 d后再次随访,治疗组的治愈率(95.13%)与总有效率(98.44%)仍明显高于对照组(治愈率34.42%、总有效率72.13%)(P0.05)。结论针刀治疗中后期指屈肌腱腱鞘炎具有较好的临床疗效。