Tenosynovitis

Dr. Diyar A. Salih

Plastic surgery resident
Dr. Diyar A. Salih
June, 2010
Plastic surgery resident
Kurdistan, Sulaimani
June, 2010
Kurdistan, Sulaimani
1) Mesenchymal syndrome: multiple
area of inflammation & tenosynovitis

Tenosynovitis: Tendon + Synovium

Tendonitis: Tendon
 Features

Sleep Repetitive motion

Size discrepancy
 Diagnosis

1) Pain at the wrist (specific comp),

exacerbated by wrist movement.
2) Tenderness on examination.
3) Grip strength decreased.
4) Complete pain relieve by a small
amount of LA agent injection in to
the compartment.
 Treatment
1) Conservative: for the first occurrence:
 Modification of activities & avoiding heavy loading
 Steroid injection (into the involve sheath)
 Splinting (short term pain Mx)
 Elastic bands (esp. Tennis elbow)
 NSAID
Triamcinolone 3-4 mg
No systemic or minimal local SE
2) Surgical: No more than 2 injection into the same
area
 Synovial
Ifsheath decompression
the first injection failed to resolve the
symptoms, there is no indication for the
 Size reduction
second injection (consider surgery)
 TendonAvoid
rerouting through another compartment
high dose:
1) Soft tissue atrophy
 Postoperative splinting
2) Skin pigment for 2 weeks & elevation
disturbance
Trigger finger

A1
Abrupt motion
(Triggering)
Usually painful

Painful nodule
1) Under LA
2) Pneumatic cuf
3) Minimal dissection
4) A2 pulley & NVB preserved
5) Confirmed by Pt to flex digit
6) Transverse incision: higher complication
7) Index finger: radial side incised
8) FPL: Transverse incision (preserve radial digital
nerve)
Congenital Trigger thumb

Notta node:
Pathological
thickening of FPL at
MCPJ
Rx:
1) Conservative: monitoring
up to 6 month of age.
2) Spontaneous resolve
(some cases)
3) Surgical:
 FPL tendon release
through transverse
incision at MCPJ
 A1 pulley released
 No tendon size
reduction is
attempted.
 De Quervain tenosynovitis

There is a high degree of

EPB
1st Ext. comp
anatomical variation in the
position of & no. of APL
tendon, it is common to APL
find separation of APL &
EPB tendon by a septum.
Radial side pain
Finklestein test 3
2
Performed in steps:
1. Ulnar deviation of the wrist
2. Passive adduction of CMCJ
3. Passive flexion of MCPJ 1
1st compartment
surgical release
Intersection syndrome
1) Conservative:
 Modification of activities & avoiding heavy loading
 Steroid injection (into the involve sheath)
 Splinting (wrist in mild extension)
C RL
E B
2) Surgical: EC R
 Second dorsal compartment synovial sheath
decompression
 Postoperative splinting for 2 weeks (wrist in moderate
extension) & elevation
EPL tendonitis

3rd comp
Lister tubercle
Increased friction &
tendonitis
 ECU tendonitis

Ulnar sided wrist pain

Triangular
fibrocartilage
complex
 ECU tendonitis

If conservative failed:
Surgical Rx:
1) Preserve volar
support
2) ECU size reduction
3) Rerouted through
fourth ext.
compartment.
Sharp curve over ridge of
Trapezium

FCU tendonitis
Trapezium ridge
Causes of pain in this site:
1) Undetected scaphoid
fracture
2) Basilar joint arthritis
3) Ganglion cyst
 Treatment:
1) Conservative
2) Surgical (synovial
sheath release)

Palmar cutaneous branch of median nerve

Runs along flexor carpi radialis
Degenerative arthritis &
bone spur formation ??
 Lateral epichondylitis
(Tennis elbow)
Burned out tendonitis

Dx
Rx: often resolve with time.
1) Conservative: including
elastic band at the border
Power grip
of thereduced
proximal and
middle third of the
ECRB muscle.
2) Surgical:
 weakening & tearing
of ECRB origin.
 ECRB origin &
periosteum excised
(if replaced by
granulation tissue as
a result of chronic or
recurrent
inflammation).
 Lateral epichondylitis
(Tennis elbow)

Radial nerve compression may coexist

Not limited to Tennis players
Surgical:
1) tearing & weakening of ECRB origin
2) Excision: granulation tissue.
 Medial epichondylitis

Pronator-flexor
Pronator-flexor
mass
mass origin
origin
 Coexist & diferentiate from

Cubital tunnel
syndrome Dx
Rx:
1) Conservative
2) Surgical:
 weakening & tearing
of PT-flexor mass
origin.
 Origin & periosteum
excised (if replaced
by granulation tissue
as a result of chronic
or recurrent
inflammation).
 Ulnar nerve
protected.
Thank you