DeeahZone.com – Acute septic arthritis is often accompanied by distal joint effusion and an underlying inflammatory process. Surgical drainage may be indicated when medical management is unsuccessful and a septic arthritis is present. In cases of a chronic inflammation, a synovial biopsy is useful to determine the cause of granulomatous changes. The indication for surgical drainage may occur when an acute infection is beyond the window of early treatment.
Extensor digitorum tenosynovitis is a common cause of wrist pain
A 65-year-old man presents with swelling in the dorsal wrist, extensor digitorum tearing and tenosynovitis. Axial T2-weighted fat-suppressed MR image shows isolated fluid distention in the fourth dorsal compartment of the wrist. He also reports pain. Extensor digitorum tenosynovitis is a common cause of wrist pain and can occur at any time.
A first intrathecal injection revealed distension of the right carpus. The injection reduced distension and revealed a large anechoic fluid deposit and synovial cell proliferation. Following a second intrathecal injection, the fluid deposits and synovial cell proliferation cleared. The patient was discharged from the hospital two weeks later. A follow-up study is necessary to monitor the patient’s progress. The aim of treatment is to restore function of the affected hand.
Giant cell tumors often invade the forelegs
Giant cell tumours are rare on the dorsum of the foot and involve the forefoot more often than the hindfoot. A recent report showed that 11 of 14 patients with a giant cell tumor of the tendon sheath had involved the forefoot and three the hindfoot. Despite the success rate, giant cell tumours are prone to recur. If the symptoms of extensor tenosynovitis are recurrent, the patient may need re-operation.
Lymphocytes were present in the fluid, suggesting lymphocytic tenosynovitis. Intrathecal injections with hyaluronic acid and daily under-saddle exercises were prescribed. Two weeks later, a steroid and HA combination was given to the patient. Under-saddle exercises were increased in intensity daily. A biopsy revealed lymphocytes, increased proteinaceous background, and an increase in viscosity. Ultimately, the patient was diagnosed with lymphocytic tenosynovitis.
The extensor tendon retinaculum lies within the tendon sheath
The extensor tendons are held in place by a structure called the extensor retinaculum. The extensor tendon retinaculum is located within the tendon sheath. It travels over the posterior area of the wrist. The synovial tendon sheath protects the tendons from friction. Further, it helps prevent injury by preventing the tendons from dislocating.
The most common type of fibroma of the tendon sheath occurs in the hands of young adults. It typically presents as a well-circumscribed, whitish lesion. It often affects the thumb, middle finger, and wrist. Less commonly, the fibroma of the tendon sheath is associated with pain and can lead to a giant cell tumor.