Long-term results following digital flexor tenosynovectomy in rheumatoid arthritis

doi:10.1016/S0363-5023(05)80433-2

The Journal of Hand Surgery

Volume 20, Issue 5, September 1995, Pages 790-794

https://doi.org/10.1016/S0363-5023(05)80433-2 Get rights and content

A retrospective review of flexor tenosynovectomy for rheumatoid flexor tenosynovitis in the palm and digit was performed. Fifteen patients (61 fingers) were reviewed for at least 1 year (average, 4 years) after surgery. An average of 2.2 cm improvement in active flexion (pulp to distal palmar crease) was observed. A significant difference in preoperative and postoperative results was found. Sixty-seven percent of digits were classified as having excellent or good results, 21% fair results, and 12% poor results. The clinical recurrence rate was 31% and the reoperation rate was 15%. Only minimal complications form the extended surgical approach were observed. Debulking the fibro-osseous canal by excising a slip of flexor digitorum superficialis was associated with a reduction in the recurrence and reoperation rates.

References (26)

ErtelAN et al.
Flexor tendon ruptures in patients with rheumatoid arthritis
J Hand Surg
(1988)
JacksonIT et al.
The extended approach to flexor tendon synovitis in rheumatoid arthritis
Br J Plast Surg
(1973)
FerlicDC et al.
Flexor tenosynovectomy in the rheumatoid finger
J Hand Surg
(1978)
BrownFE et al.
Long term results after tenosynovectomy to treat the rheumatoid hand
J Hand Surg
(1988)
BolandDM et al.
Rheumatoid disease
Hand Clin
(1989)
NalebuffEA
Surgical treatment of rheumatoid tenosynovitis in the hand
Surg Clin North Am
(1969)
DucheR et al.
Tenosynovectomie des flechisseurs dans la polyarthrite rhumatoide
Ann Chir Main
(1993)
MillenderLH et al.
Preventive surgery: tenosynovectomy and synovectomy
Orthop Clin North Am
(1975)
HarrisonSH et al.
Flexor synovectomy in the rheumatoid hand
Hand
(1976)
TonkinMA et al.
Lateral band translocation for swan-neck deformity
J Hand Surg
(1992)

StirratCR

Treatment of tenosynovitis in rheumatoid arthritis

Hand Clin

(1989)

MillenderLH et al.

Evaluation and treatment of early rheumatoid hand involvement

Orthop Clin North Am

(1975)

BrewertonDA

Hand deformities in rheumatoid disease

Ann Rheum Dis

(1957)

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Citation Excerpt :
One study has demonstrated a clinical recurrence rate of 31% after flexor teno-synovectomy with a re-operation rate of 15% but the unfortunately did not state a time period. Furthermore the report also has stated that debulking the fibro-osseous canal by excising a slip of flexor digitorum superficialis was associated with a reduction in the recurrence and re-operation rate.28 However, to the best of our knowledge, the authors of this report are unaware of a case of bilateral wrist flexor tensosynovitis that has recurred within five months of a previous synovectomy.
Rice body formation has been traditionally observed in the joint and tendon sheaths of patients with tuberculosis. Few case reports exist that describe rice body formation in patients with rheumatoid arthritis. We describe a case report of bilateral recurrent wrist flexor tenosynovitis with rice body formation in a patient with sero-negative rheumatoid arthritis.
This case report describes a 72 year old lady presenting with severe bilateral, flexor tenosynovitis of the wrists. Ultrasonography revealed significant echogenic fluid on the palmer aspect of wrist joint surrounding flexor tendons with intact neurovascular bundles and no bony erosion. Laboratory tests demonstrated elevated erythrocyte sedimentation rate (50 mm/h) and negative rheumatoid factor. A sequential subtotal flexor tenosynovectomy was carried out with decompression of the carpal tunnel. During the operation, multiple rice bodies among the flexor tendons with adherent synovitis were found. Histology revealed disrupted synovial tissue containing several areas of fibrinoid necrosis, bounded by a layer of vaguely pallisaded histiocytes but no epitheloid granulomata or germinal centre. A revision surgery with debulking of the fibro-osseous canal was undertaken following recurrence. The patient presently has complete resolution of symptoms at one year follow-up.
The combined clinical, laboratory, ultrasound and histology findings of the patient indicated that the cause of the rice body formation was due to a sero-negative arthritis rather than tuberculosis.
Rice body formation can be caused by sero-negative arthritis. Bilateral wrist flexor tensosynovitis can recur within five months of a previous synovectomy in a patient with sero-negative arthritis.
Interobserver Reliability of the Amsterdam Severity Scale in Stenosing Tenosynovitis (ASSiST)
2009, Journal of Hand Therapy
Interobserver reliability study.
A scale was developed to measure the severity of stenosing tenosynovitis: the Amsterdam Severity Scale in Stenosing Tenosynovitis (ASSiST).
To study the interobserver reliability of the ASSiST.
Patients suffering from various impairments in hand function were referred to our outpatient hand clinic. The grading of stenosing tenosynovitis was assessed independently. The observers were blinded for each other's results. The ASSiST distinguishes between a nodular and a diffuse form. The severity was graded from grades 0 to 3.
Kappa coefficient for the distinction between the four grades was 0.72 (95% confidence interval [CI] 0.59–0.85) and for the distinction between the nodular and the diffuse forms 0.16 (95% CI 0.13–0.18).
The ASSiST can be used to reliably assess the severity of stenosing tenosynovitis in both nodular and diffuse forms, but it does not differentiate between these two forms.
Not applicable.

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¹: From the Department of Hand Surgery, Royal North Shore Hospital, St. Leonards, Australia

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Long-term results following digital flexor tenosynovectomy in rheumatoid arthritis*

J Hand Surg

Br J Plast Surg

J Hand Surg

J Hand Surg

Hand Clin

Surg Clin North Am

Ann Chir Main

Orthop Clin North Am

Hand

J Hand Surg

Hand Clin

Orthop Clin North Am

Hand deformities in rheumatoid disease

Ann Rheum Dis