Tenosynoviti

s
Dr. Diyar
A. Salih
Plastic
surgery
resident
June, 2010
 l e s
t s ty
t e x
1) Mesenchymal syndrome: t e r
multiple area of a s
inflammation & i t M
tenosynovitis ed o vel
t
ic k l e l
Cl cond rd levelevel el
e
S i h v
T h Fo u r t f t h l e
●
●
●
Fi

Tenosynovitis: Tendon +
Synovium

Tendonitis: Tendon
 Features
Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level

ØSleep Repetitive
Ø

ØSize motion
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
Triamcinolone
§ 3-4 mg elbow)
No systemic or minimal local SE
§
● NSAID §No more than 2 injection into the

same area
§If the first injection failed to

1) Surgical: resolve the symptoms, there is no

indication for the second injection
(consider surgery)
● Synovial sheath decompression
§Avoid high dose:

● Size reduction 1) Soft tissue atrophy

2) Skin pigment disturbance
● Tendon rerouting through another
Trigger finger

A
1
Abrupt motion
(Triggering)
Usually painful
 Click to edit Master text sty
Under LA
1)

2) Pneumatic cuff
Second level
● Third level
3) Minimal dissection
4) A2 pulley & NVB preserved ● Fourth level
Confirmed by Pt to flex digit
● Fifth level
5)

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. Click to edit Master text styles
2) Spontaneous Second level
resolve (some ● Third level
cases) ● Fourth level
3) Surgical:
● Fifth level
4) FPL tendon
release through
transverse
incision at MCPJ
5) A1 pulley released
6) No tendon size
reduction is
attempted.
 Click to edit Master text styles
De Quervain Second level
● Third level

tenosynovitis ● Fourth level

● Fifth level

There is a high
EPB 1st Ext.
degree of
anatomical
comp
variation in the
APL
position of & no. of
APL tendon, it is
common to find
separation of APL &
EPB tendon by a
septum.
Radial side pain
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Second level
● Third level

● Fourth level

● Fifth level
 Click to edit Master text styles
Finklestein Second level 3
test ● Third level

2 level
● Fourth

● Fifth level

Performed in steps:
1. Ulnar deviation of the
wrist
2. Passive adduction of 1
CMCJ
3. Passive flexion of MCPJ
 Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level

1st
compartment
surgical release
 S hi r d e v e l
T r th l
u el
●
● F o l e v
Intersection ● Fi
fth

syndrome
1) Conservative:
● Modification of activities & avoiding heavy loading
● Steroid injection (into the involve sheath)
●

R L
Splinting (wrist in mild extension)
C
E R
1) Surgical: E C
●
B
Second dorsal compartment synovial sheath
decompression
● Postoperative splinting for 2 weeks (wrist in
moderate extension) & elevation
 ● Fifth level

EPL tendonitis

3rd
comp
Lister tubercle
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Increased
Second level friction &
● Third level
tendonitis
● Fourth level

● Fifth level
ECU tendonitis

Ulnar sided
wrist pain
Triangula
r
fibrocartil
age
complex
ECU tendonitis

If conservative
failed:
Surgical Rx:
1) Preserve
volar support
2) ECU size
reduction
3) Rerouted
through
● Fifth level

Sharp curve over ridge

of Trapezium

FCU
tendonitis
Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level

Trapezi
um
ridge
Causes of pain in
this site:
1) Undetected
scaphoid
fracture
2) Basilar joint
arthritis
3) Ganglion cyst
 Treatment:
1) Conservativ

e
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:
Power including
grip elastic
band at the border
reduced of the proximal
ECRB
and middle third
of the muscle.
2) Surgical:
3) weakening &
tearing of ECRB
origin.
4) ECRB origin &
periosteum
excised (if
replaced by
granulation tissue
Click to edit Master text styles
Second level Lateral
● Third level epichondylitis
● Fourth level
(Tennis elbow)
● Fifth level

Radial nerve compression

may coexist
 Not limited to Tennis
players
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Second level
● Third level

● Fourth level

● Fifth level
Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level

Surgical:
1) tearing & weakening of
ECRB origin
2) Excision: granulation tissue.
 Medial
epichondylitis

Pronator-
flexor mass
origin
 Coexist & differentiate from

Cubital
tunnel
syndrome §Dx
§Rx:

1) Conservative
2) Surgical:
3) weakening &
tearing of PT-
flexor mass origin.
4) Origin &
periosteum
excised (if
replaced by
granulation tissue
as a result of
chronic or
recurrent
inflammation).
5) Ulnar nerve
protected.
Thank you