The outpatient treatment of pyogenic flexor tenosynovitis

Historically, pyogenic flexor tenosynovitis has been treated with surgical debridement followed by hospitalization and administration of intravenous antibiotics. Recently, hand surgeons have treated this disorder on an outpatient basis. We retrospectively reviewed 37 patients with pyogenic flexor tenosynovitis who were managed as outpatients. Each patient underwent operative irrigation and debridement with intraoperative catheter irrigation. Postoperatively, patients were treated with outpatient intravenous antibiotics. Conversion to oral antibiotics was based on intraoperative culture results. Using this protocol, the average length of intravenous antibiotic usage was 3.5 days. Of the 28 patients with documented follow-up, 27 resolved the infection and one had a recurrence of the infection. No amputations were noted. Total active motion measurement was obtained from 15 patients showing good or excellent results in 14 of 15 patients. This preliminary retrospective case cohort suggests favorable results with outpatient treatment of pyogenic flexor tenosynovitis.     

微创松解疗法治疗指屈肌腱狭窄性腱鞘炎研究

中医小针刀微创松解疗法治疗指屈肌腱狭窄性腱鞘炎——"扳机指",具有比较满意的疗效。近年来许多临床医生利用自制小尖刀、斜刃刀、虹膜刀、镰状弯刀、推割刀等改进刀具替代传统小针刀,改变原小针刀垂直多刀刺切法,采取微型切口,沿指屈肌腱走行方向纵向钩切、挑割、直线推割等方式,彻底切开出现狭窄病变的腱鞘滑车,达到松解目的。术中需要注意:全面细致地了解指屈肌腱以及周围组织的解剖层次、结构关系;严格掌握指屈肌腱狭窄性腱鞘炎微创松解疗法的适应证;熟练掌握专用微创松解针、刀具以及规范化操作方法;术前准确定位,术中按顺指屈肌腱走行方向,沿肌腱正中连续切开松解的方法,完全可以达到与传统切开手术相同甚至更高的松解疗效,同时还可避免常见不良并发症的发生。     

微创松解疗法治疗指屈肌腱狭窄性腱鞘炎研究

目的:评价Centerpiece钢板在颈椎单开门术中应用价值及相对于传统丝线缝合固定方法的优缺点.方法:自2009年12月至201 1年8月,采用手术治疗脊髓型颈椎病32例,其中采用颈后路单开门椎板成形术加Centerpiece钢板内固定治疗15例(A组),男8例,女7例;年龄51～65岁,平均60.5岁;病程2～15个月.采用传统颈椎椎管单开门扩大成形术(丝线缝合固定)治疗17例(B组),男9例,女8例;年龄49～66岁,平均61.5岁;病程1～14个月.两组患者术前均存在不同程度的行走不稳症状,颈椎MRI上可见颈髓受压明显伴有脊髓变性.按日本矫形外科学会(JOA)评分法分别在术前和术后6个月对患者脊髓神经功能进行评分,测定患者术前及术后CT上椎管矢状径(AP)及颈椎活动度(ROM).结果:32例患者均获得随访,时间8～20个月,平均13个月.所有切口愈合良好,未出现内固定松动、断裂及脊髓损伤加重等并发症.术后症状均明显恢复,复查MRI、颈椎CT见椎管容积明显扩大,术后随访无再关门及钢板螺钉松动的异常情况. A组平均手术时间、出血量分别为(155±12.3) min、(407±11.8) ml;B组平均手术时间、出血量分别为(148±14.4) min、(398±15.4) ml,两组比较均无统计学意义(P＞0.05).JOA评分A组由术前的9.1±2.6提高到术后的15.5±1.8,B组由术前的9.3±2.1提高到术后的13.1±2.5,差异均有统计学意义(P＜0.05).椎管矢状径(AP)A组由术前的(10.7±2.4) mm提高至术后的(17.6±3.2) mm;B组由术前的(11.6±1.7) mm提高至术后的(15.9±2.0) mm,差异均有统计学意义(P＜0.05).颈椎活动度(ROM)A组手术前后分别为(51.0±2.6)°和(45.0±3.5)°,B组分别为(52.0±1.8)°和(42.0±2.4)°,两组术前颈椎活动度差异无统计学意义(P＞0.05),术后颈椎活动度差异有统计学意义(P＜0.05).结论:颈后路单开门椎板成形术加Centerpiece钢板内固定治疗脊髓型颈椎病相对于传统颈椎榷管单开门扩大成形术(丝线缝合固定),即能更好的恢复椎管容积,又能较好的保持患者原有颈椎活动度,还能更好的改善术后JOA评分.因此相对于传统缝合固定方法具有明显的优势.     

Semimembranosus tenosynovitis: operative results

Semimembranosus tenosynovitis is a common knee problem in the over-50 age-group, occurring mainly in women. It affects the reflected portion of the tendon of the semimembranosus muscle as well as the bursa below it. The tendon becomes inflamed as a result of friction at the entrance to the bony canal (semimembranosus groove), especially if osteophytes are present on the edges of the groove. Conservative treatment includes anti-inflammatory drugs, ultrasound, and friction massage. If necessary, nonresponders may be given local injection of 40-80 mg methylprednisolone acetate with 1% Xylocaine. Between 1979 and 1983 we operated on 16 patients who had not obtained relief even after three or four injections. The approach in each case was through a posterior medial oblique incision. The semimembranosus osteofibrotic tunnel was revealed and the fibrous sheath surrounding the tendon was excised. Good results were obtained in eight patients in whom the inflammatory process had been localized to only the semimembranosus insertion area: eight patients in whom the knee joint or the pes anserinus insertion was also involved achieved fair or poor results. The operation is not advised for young athletes because of the important function of the reflected head of the semimembranosus muscle.     

Purulent flexor tenosynovitis: factors influencing the functional outcome

This retrospective study aimed to evaluate the factors that influence the final outcome of treatment of purulent flexor tenosynovitis, viz. delay in treatment, severity of the condition, the infecting pathogen and the method of treatment. Of 41 patients with this condition treated by drainage and irrigation through two small incisions (16) and wide incision (25), 16 were treated after a delay. Continuous postoperative irrigation was applied in 26 patients. Re-operation was necessary in 11 patients. In most cases, Staphylococcus aureus was detected. The results were excellent in 32 cases and the mean Disabilities of the Arm, Shoulder and Hand score was 8.1. Irrigation through small incisions and continuous postoperative irrigation decreased the probability of an unfavourable outcome. Delayed treatment and infections with specific pathogens led to a worse outcome. Early diagnosis of purulent flexor tenosynovitis followed by drainage through small incisions and continuous postoperative irrigation appear, from this retrospective review, to lead to the best functional outcome.     

Semimembranosus tenosynovitis: Operative results

Summary Semimembranosus tenosynovitis is a common knee problem in the over-50 age-group, occurring mainly in women. It affects the reflected portion of the tendon of the semimembranosus muscle as well as the bursa below it. The tendon becomes inflamed as a result of friction at the entrance to the bony canal (semimembranosus groove), especially if osteophytes are present on the edges of the groove. Conservative treatment includes anti-inflammatory drugs, ultrasound, and friction massage. If necessary, nonresponders may be given local injection of 40–80 mg methylprednisolone acetate with 1% Xylocaine. Between 1979 and 1983 we operated on 16 patients who had not obtained relief even after three or four injections. The approach in each case was through a posterior medial oblique incision. The semimembranosus osteofibrotic tunnel was revealed and the fibrous sheath surrounding the tendon was excised. Good results were obtained in eight patients in whom the inflammatory process had been localized to only the semimembranosus insertion area: eight patients in whom the knee joint or the pes anserinus insertion was also involved achieved fair or poor results. The operation is not advised for young athletes because of the important function of the reflected head of the semimembranosus muscle.     

Sarcoid flexor tenosynovitis of the finger: a case report

A case report of flexor tenosynovitis of the right ring finger in a 27-year-old black woman leading to the diagnosis of sarcoidosis is presented. Sarcoidosis of a flexor tendon sheath is rare. Flexor tenosynovectomy provided material for histologic diagnosis and increased the function of the hand.     

Rat bite fever with flexor tenosynovitis: case report and review

The term rat bite fever (RBF) designates pyrexia and systemic disease caused by the gram-negative bacteria Streptobacillus moniliformis, common in North American and European rats, and transmitted by their bite. Despite low transmission rates of 10%, this systemic disease has a mortality of around 15% when untreated and has serious consequences for at risk populations such as the immune compromised.     

Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment

OBJECTIVE: We present the incidence and results of treatment of symptomatic physiologic hydronephrosis in 3,400 pregnant women. METHODS: We analyzed 103 consecutive women who presented with clinical signs and symptoms related to the upper urinary system. Renal sonography, urinalysis, serum creatinine levels, white blood cell (WBC) count, and urine culture were done in all patients at first visit and repeated at least once a month until 1 month after delivery. In patients who manifested acute pyelonephritis, urinalysis, WBC count, erythrocyte sedimentation rate and C-reactive protein levels were repeated every 3 days until normalization, and urine culture as well as renal sonography were performed once a week until 1 month after delivery. Conservative measures (positioning, analgesia, antibiotics) were performed in all patients with symptomatic physiologic hydronephrosis. If the patient's condition was refractory to medical management, drainage of the ureter with a double pigtail stent was performed. RESULTS: Conservative measures were successful in 97 (94%) of 103 patients but 6 (6%) patients had ongoing signs and symptoms of acute pyelonephritis progressing to urosepsis. In all of them, antibiotics were continued and a double pigtail stent was placed resulting in fast regression of symptoms, curing of renal infection and progress of the pregnancies to the term with vaginal delivery. CONCLUSIONS: Symptomatic hydronephrosis in pregnancy can be treated conservatively. If the patient's condition is refractory to medical management, an internal drainage with double pigtail stent may be necessary.     

Factors affecting the prognosis of pyogenic flexor tenosynovitis

BACKGROUND: Pyogenic flexor tenosynovitis is a closed space infection involving the digital flexor tendon sheaths of the upper extremity that can cause considerable morbidity. The purpose of the present report is to describe the various risk factors leading to poor outcomes and to recommend a clinical classification system for this condition. METHODS: We studied seventy-five patients with pyogenic flexor tenosynovitis over a six-year period. The amputation rate and total active motion were used as outcomes measures. The clinical factors influencing outcomes were identified and analyzed. RESULTS: The five risk factors associated with poor outcomes were (1) an age of more than forty-three years, (2) the presence of diabetes mellitus, peripheral vascular disease, or renal failure, (3) the presence of subcutaneous purulence, (4) digital ischemia, and (5) polymicrobial infection. On the basis of the clinical findings and outcomes, three distinct groups of patients could be identified, each with a progressively worse outcome. Patients in Group I had no subcutaneous purulence or digital ischemia; these patients had the best prognosis, with no amputations and a mean 80% return of total active motion. Patients in Group II demonstrated the presence of subcutaneous purulence but no ischemic changes; these patients had an amputation rate of 8% and a mean 72% recovery of total active motion. Patients in Group III had both extensive subcutaneous purulence and ischemic changes; these patients had the worst prognosis, with an amputation rate of 59% and a mean 49% return of total active motion. CONCLUSIONS: We propose a three-tier clinical classification system that can aid in prognosis and guidance in the treatment of pyogenic flexor tenosynovitis of the upper extremity.     

Gouty flexor tenosynovitis of the digits: report of three cases

Gouty tenosynovitis in the hand is a rare entity. To date the limited cases described have involved predominantly extensor tendons in the fingers and flexor tendons in the palm or wrist. Flexor tendon involvement is less common and has been reported only twice to our knowledge distal to the palm. We report 3 cases of extra-articular gout presenting as tophaceous involvement of flexor tendons in the fingers. All cases were treated surgically. These cases are presented to heighten awareness of this rare entity and to provide a setting for a discussion of management.     

玻璃酸钠治疗指屈肌腱腱鞘炎113例(129指)效果观察

[目的]探讨玻璃酸钠治疗指屈肌腱腱鞘炎的临床效果和应用。[方法]将113例（129指）指屈肌腱腱鞘炎，按临床症状分为Ⅰ～Ⅳ期。均采用玻璃酸钠注射液2ml，配合2％利多卡因1 ml，行鞘管内注射。每周1次，5次为1个疗程。[结果]平均随访13个月，129指显效率64．0％，有效率32．0％，无效率4．0％。治疗3次，手指功能的恢复强于疼痛症状的改善。1个疗程后总有效率96．0％。[结论]玻璃酸钠治疗指屈肌腱腱鞘炎，疗效肯定，作用持久，是一种安全有效的方法。     

Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis

The records of 75 patients admitted with pyogenic flexor tenosynovitis at two academic centers were reviewed. The functional outcomes of patients who received intraoperative irrigation only (n = 20) and those that had both intraoperative irrigation and continuous postoperative irrigation (n = 55) were compared. There were no statistically significant differences between the outcomes in the two groups.     

Closed-catheter irrigation is as effective as open drainage for treatment of pyogenic flexor tenosynovitis

Surgical treatment of pyogenic flexor tenosynovitis traditionally consists of open drainage (OD) and irrigation of the flexor tendon sheath. An alternative, less traumatic method of closed-catheter irrigation (CCI) has been advocated, but no comparative studies have been reported. The authors reviewed 47 cases of pyogenic flexor tenosynovitis to determine whether a difference in outcomes exists between these two methods. OD was used in 32 patients and CCI was used in 15 patients. Complications appeared to be more common in the OD group (N = 9) compared with the CCI group (N = 3), but this difference was not significant. This study supports the use of CCI as the preferred treatment for pyogenic flexor tenosynovitis because it provides thorough mechanical tendon sheath irrigation and causes smaller wounds with less scarring, which may offer a more rapid return to function.