1/289. Isolated tenosynovitis associated with psoriasis triggered by physical injury. A 60-year-old man who had been suffering from psoriasis for 20 years developed finger dactylitis and inflammatory swelling with pitting edema over the dorsum of the hand one week after a contusive trauma to the left hand. These were not followed by any other clinical manifestations of PsA. ( info) |
2/289. Scintigraphy of de Quervain's tenosynovitis. The scintigraphic pattern of de Quervain's tenosynovitis has not previously been described. Similar three-phase bone scintigraphy patterns were found in four patients with this condition. The characteristic abnormalities consisted of an elongated area of increased uptake in the blood flow and blood pool phases in the anatomical course of the first dorsal compartment of the wrist, together with increased focal uptake of 99Tcm-MDP in the radial styloid on the delayed images. This pattern should be recognized and included in the differential diagnosis of increased uptake of 99Tcm-MDP in the radial compartment of the wrist. ( info) |
| The authors describe an uncommon case of flexor tenosynovitis caused by mycobacterium terrae, an atypical mycobacterium generally considered nonpathogenic in humans. A prolonged delay in diagnosis and various ineffective therapies led to synovial biopsy and culture. After confirming the diagnosis of M. terrae, appropriate antimycobacterial chemotherapy resolved the synovitis. For chronic tenosynovitis without a clear etiology, limited synovectomy and culture are essential in establishing a diagnosis and in initiating treatment for this atypical mycobacterial infection. ( info) |
4/289. Save that arm: a study of problems in the remaining arm of unilateral upper limb amputees. A study has been made by questionnaire, personal examination and telephone interview of unilateral upper limb amputees seen at the Prince Henry Hospital, australia between 1994 and 1997. There were 60 questionnaires posted. Replies were received from 46. Problems were noted in the remaining arm of 23 (50%). The respondents' problems not only consisted of overuse symptoms, but also of an exacerbation of pre-existing arthritis and injury due to trauma to the remaining arm during the accident. Case histories are given in 3 typical cases. Treating professionals are warned about the hazards that one arm amputations present to the remaining arm. ( info) |
5/289. Os trigonum syndrome with flexor hallucis longus tenosynovitis in a professional football referee. The presentation of posterior ankle pain in any patient poses a diagnostic dilemma. The os trigonum syndrome and flexor hallucis longus stenosing tenosynovitis have been reported to occur in professional and amateur ballet dancers. It is important to consider these diagnoses in a patient who is not a dancer, as is shown in the case presented here. The patient in this case is a professional referee who injured his ankle while working on artificial turf. The treatment for os trigonum syndrome and flexor hallucis longus tenosynovitis is initially conservative, but in refractory cases, surgical removal of the os and release of the flexor hallucis longus tendon can be successfully performed. This is the first reported case of os trigonum syndrome and flexor hallucis longus tenosynovitis presenting simultaneously in a patient who is not a dancer. ( info) |
6/289. Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. We report three patients with lateral ankle and foot pain, with the diagnosis of stenosing tenosynovitis of the peroneus longus tendon associated with a markedly enlarged peroneal tubercle. Stenosing tenosynovitis of the peroneus longus tendon associated with an atraumatically enlarged peroneal tubercle has rarely been reported, and these reported cases were associated with an os peroneum. One of our patients had no demonstrable associated os peroneum but did have a bony tunnel enveloping the peroneus longus tendon. Our other two patients had an os peroneum, but were asymptomatic at the lateral outer border of the cuboid tunnel; one patient had involvement of the peroneus longus and brevis tendons. ( info) |
7/289. Distal extremity swelling with pitting edema in psoriatic arthritis: evidence of 2 pathological mechanisms. Distal extremity swelling with pitting edema due to altered lymphatic drainage has been reported in some patients with psoriatic arthritis (PsA). The edema usually affected the upper limbs in an asymmetric pattern and was resistant to therapy. We describe 2 additional cases. The distal swelling and pitting edema responded promptly and completely to corticosteroids in the first patient but persisted in the second. lymphoscintigraphy and magnetic resonance imaging (MRI) revealed a predominant tenosynovitis in the hand without lymphedema in the first patient, and impaired lymphatic drainage without tenosynovial sheath involvement in the second. We conclude that 2 different mechanisms, characterized by a different response to therapy, may be associated with the same clinical picture of distal swelling with pitting edema in patients with psoriatic arthritis. lymphoscintigraphy and MRI are useful in defining the structures involved and in predicting the prognosis. ( info) |
8/289. Sesamoiditis of the index finger presenting as acute suppurative flexor tenosynovitis. Sesamoiditis involving the hand is uncommon, usually reported in the thumb, and has not been reported in the index finger. As rare as this clinical entity remains, its presentation simulating an acute suppurative flexor tenosynovitis is even more rare. We report a patient who presented with Kanavel's 4 cardinal signs of acute suppurative tenosynovitis who was subsequently found to have an acute sesamoiditis of the index finger. This finding was supplemented by a cadaveric and radiographic study to better delineate the anatomy of the index sesamoid and further explain the clinical presentation. ( info) |
9/289. Intersection syndrome: a case report and review of the literature. Intersection syndrome is a condition that should be differentiated from DeQuervain's stenosing tenosynovitis, as there are many subtle differences in treatment and prognosis. We present a case of intersection syndrome, describing its characteristic clinical and anatomic features, and highlighting differences in the areas of diagnosis and treatment relative to the better known DeQuervain's tenosynovitis. ( info) |
10/289. Infections of the hand. In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua new guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Some of the more complicated infections such as middle palmar and thenar space infections, suppurative tenosynovitis, osteomyelitis and septic arthritis are of sufficient importance to warrant the attentions of the specialist surgeon when this is possible. ( info) |