Nontuberculous Mycobacterial Tenosynovitis in the Hand: Two Case Reports with the MR Imaging Findings

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.     

Trigger Wrist

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.     

Granulomatous infection of the hand and wrist due to Azospirillum spp.

We report a case of Azospirillum infection manifestating as granulomatous tenosynovitis of the right hand, in an immunocompetent middle-aged female. We highlight the unusual source of the infection, the diagnostic workup, as well as the treatment approach.     

阿是穴压灸法治疗拇指屈肌腱鞘炎疗效观察

目的：比较不同无疤痕灸法对拇指屈肌腱鞘炎的疗效.方法：120例患者随机分为3组,艾灸1组采用阿是穴压灸法,艾灸2组采用阿是穴直接灸法,艾灸3组采用艾条悬灸法,每天治疗1次,共治疗5次.结果：艾灸1组治愈率95%,艾灸2组治愈率70%,艾灸3组治愈率65%.艾灸1组疗效明显优于艾灸2、3组（P＜0.05）.艾灸2组优于艾灸3组,但差异无统计学意义（p＞0.05）.结论：阿是穴压灸法能有效治疗拇指屈肌腱鞘炎.     

超声引导下针头挑拨治疗手部狭窄性腱鞘炎

目的探讨超声引导下针头挑拨治疗手部狭窄性腱鞘炎疗效. 方法回顾性对比分析78例手部狭窄性腱鞘炎的治疗效果,按挑拨方法的不同分为2组.治疗组在10MHz超声引导下用20号注射针头挑拨并划开狭窄的腱鞘,对照组盲视下穿刺并挑拨. 结果术后4周随访时治疗组疼痛消失32例(82.1%),对照组20例(51.3%),差异有显著性(χ2=8.34,P=0.004).治疗组VAS值(疼痛强度视觉类比评分)比术前减少8.9～3.5,平均6.7±2.0,对照组VAS值比术前减少8.5～0.5,平均5.2±2.9.治疗组疼痛缓解明显优于对照组(t=2.659,P=0.010). 结论超声引导下将针头穿刺于腱鞘内腱周前划开狭窄的腱鞘是手部狭窄性腱鞘炎的一种简单、微创且有效的治疗方法.     

Quantitative evidence of kinematics and functional differences in different graded trigger fingers

Background

Clinical diagnosis and classification of trigger fingers is traditionally based on physical examinations and certain obvious symptoms. However, it might lack quantitative evidence to describe the different graded trigger digits. This study provides quantitative evidence of kinematics and functional differences among different graded trigger fingers based on Froimson's classification.

Methods

Forty-seven patients with fifty-five trigger fingers and graded twenty-three, eleven, and twenty-one fingers as grades II, III, and IV, respectively. The QuickDASH questionnaire evaluated the subject's self-perception of hand symptoms and functions. The study measured maximal workspace of the fingertip motion and range of motion of the finger joints during an assigned tendon-gliding task using an electromagnetic tracking device. In addition, R_α, defined as the ratio range of angular acceleration during finger extension to the range during finger flexion of each joint, quantified the triggering effect.

Findings

The QuickDASH score results show that functional performances have significant differences among three grades (P < 0.05). Workspace, range of motion of proximal interphalangeal joint and R_α of proximal interphalangeal and distal interphalangeal joint of trigger fingers also significantly differ among three grades (P < 0.05). These findings quantitatively show that trigger fingers in different impairment levels have different kinematics and functional performances.

Interpretation

The results serve as evidence-based knowledge for clinics. The more practical and immediate application of this study would be to facilitate the assessment, design and execution of rehabilitation for patients with trigger fingers.     

Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature

Proliferative flexor tenosynovitis of the hand is an inflammatory process involving the synovial sheaths surrounding the tendons. It is most commonly caused by infection, but may also be caused by overuse, diabetes and rheumatic conditions such as rheumatoid arthritis and crystal arthropathies. The present report describes two patients with severe proliferative tenosynovitis, who developed a fistula between the tendon sheath and skin after instrumentation, resulting in persistent synovial drainage. After failing conservative management, both patients were managed with extensive flexor tenosynovectomy to prevent inoculation of bacteria into the flexor sheath. The presentation, management and outcome of each case is described in addition to a discussion of the literature on tenosynovial fistulas.