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Acute calcific tendinitis of the hand is rare and often misdiagnosed as infection, fracture or periarthritis. It frequently occurs in peri-menopausal women and is caused by deposits of hydroxyapatite crystals. We describe acute calcific tendinitis of the flexor digitorum superficialis insertion in an elderly man taking oral anticoagulants. The differential diagnoses and recommended treatment are discussed.

An unusual case of a 52-year-old woman with tenosynovial osteochondromatosis involving both of the wrist flexor and extensor tendons is reported.

A 52-year-old woman with systemic lupus erythematosus (SLE) was infected with tuberculosis (TB) on her forearm and hand, after 16 years of steroid therapy. Debridements and anti-TB therapy were performed successfully. Recently, the risk of significant morbidity from TB has been on the rise; this appears to be a complication of steroid therapy used to treat AIDS and some collagen vascular diseases. It is thought that steroid therapy causes an increased risk of TB. In this paper, we report our experience of this SLE patient who developed tuberculous tenosynovitis. We suggest that TB infection must be considered in the differential diagnosis whenever a patient presents with a chronic wrist or hand inflammation that is non-responsive to steroid treatment. Once TB infection is suspected, both histopathological and bacteriological examinations should be performed. Emergent treatment includes surgical debridement and the institution of early anti-TB therapy immediately after completing histopathological examination.

The main complaint of the patients after an open trigger finger release is a discomfort at the incision site. In this prospective study, we compared the two consecutive groups of patients with trigger fingers. One was treated by an open approach and the other by the endoscopic release of the A1 pulley. Pre- and post-operative evaluation at seven, 30 and 90 days showed a faster recovery from the discomfort with a faster return to daily and working activities, after the endoscopic procedure.

Six cases of culture-proven Mycobacterium chelonae tenosynovitis were identified through retrospective chart review. Fifteen cases were identified using computerised Medline search. Clinical features, treatment and outcome were described. Infection control was achieved in our patients with an average of 3.2 surgeries each and antibiotic treatment for six months to one year. Eleven published cases were managed by combined surgery and systemic antibiotics, with an average of 1.73 surgeries per patient and seven weeks to 24 months of antibiotics. All our patients were disease free on final follow-up. Thirteen cases were resolved. Functional outcomes were reported for eight cases. Comparison of functional outcome was not possible because different parameters were used in different reports. Aggressive debridement, susceptibility-guided antibiotics, and supervised rehabilitation resulted in infection control and acceptable hand function for our patients. Standardised data collection on subsequent cases would facilitate outcome monitoring and formulation of a treatment guideline for this disease.

De Quervain disease is caused by a stenosing tenosynovitis in the first dorsal compartment, and the main aetiology is extensor pollicis brevis (EPB) tenosynovitis. We encountered three cases in which EPB tenosynovitis was absent and abductor pollicis longus (APL) tenosynovitis was confirmed during operation. In the treatment of de Quervain disease, APL tenosynovitis should be paid as much attention as EPB tenosynovitis.

Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.

Acute cutaneous leishmaniasis is a parasitic infectious disease prevalent in tropical areas. Most doctors in non-endemic countries are not familiar with this disease. Spontaneous tendon ruptures occurring by different mechanisms have been described in the literature but a tendon rupture caused by a skin ulcer secondary to a parasitic infection has not been reported before. In this article clinical and diagnostic features of cutaneous leishmaniasis are reviewed and a case with spontaneous extensor tendon rupture due to cutaneous leishmaniasis is presented.

Mycobacterium marinum infection could have various presentations, from superficial skin infection to deep structure destruction. The prognosis is relatively poor when deep structure is involved as it is more destructive. The prognosis is even worse when operation is required. In the retrospective study of 136 patients who suffered this disease with deep structure involvement, their clinical presentations could be classified into benign and aggressive type. It was found that both types of presentation could be treated conservatively by medication alone. Benign presentations could be treated successfully with chemotherapy alone without complications. Patients with aggressive presentation were usually associated with worse prognosis as there were more complications regardless of the management option. Therefore, the clinical presentation not only had prognostic value but could also guide the treatment plan.

We report an extreme case of Mycobacterium kanasii flexor tenosynovitis with flexor tendon rupture in a healthy 65-year-old left-hand dominant Caucasian housewife.

This case highlights the diagnostic conundrum of atypical mycobacteria infections due to their insidious presentation, the need for a high index of suspicion to prevent worsening or delaying the diagnosis from inappropriate steroid use and that these infections can occur in otherwise healthy individuals.

Background: Chronic tenosynovitis of the wrist and hand is commonly seen by orthopedists, especially hand surgeons. However, cases with rice body formation are comparatively rare. Thus, we retrospectively reviewed the cases of chronic tenosynovitis in our department and evaluated the necessity of antibiotic therapy in the early post-surgical stage.

Methods: We analyzed the medical and surgical records of patients who had undergone surgery for chronic tenosynovitis with rice body formation in our department from 1997 to 2015. We evaluated the causes of chronic tenosynovitis, culture findings, pathological findings, and post-operative treatment courses.

Results: Nineteen patients with 23 involved hands underwent surgery for chronic tenosynovitis, and 9 patients had rice body formation. The most common cause of chronic tenosynovitis was non-tuberculous mycobacteriosis, and other causes were fungal infection and infection of unknown origin. Recurrence was observed in 2 cases of mycobacteriosis and 1 case of fungal infection; 1 case of mycobacteriosis also had a re-recurrence.

Conclusions: In the diagnosis of chronic tenosynovitis with rice body formation, it is necessary to consider not only non-tuberculous mycobacteriosis, but also fungal infection as its origin. However, it is difficult to define the cause of synovitis, but in cases in which these infections are suspected, anti-bacterial therapy in the early post-surgical period could be effective.

We present a rare case of primary tuberculous tenosynovitis in a young patient with an acute history of non-penetrating traumatic injury. The patient had recently visited Pakistan and presented with sudden onset pain at the base of their right fifth digit after trying to catch a cricket ball. A provisional diagnosis of haematoma was made; however, ultrasonography revealed a mass attached to the A2 pulley. Surgical excision followed by histological examination and culture identified Mycobacterium Tuberculosis infection. This case serves to raise clinical awareness of this rare condition and highlight the importance of obtaining a travel history.

Background: DeQuervain tenosynovitis, refractory to medical conservative treatment, has been traditionally treated by a simple division of the pulley, a procedure associated with several complications. Many authors attempted to prevent these complications by describing techniques of pulley reconstruction after its release necessitating suturing the different flaps and subsequently promoting extensor tendons adhesions. The authors present an alternative procedure for the first extensor compartment pulley decompression: “Omegaplasty”.

Methods: 25 Patients with 29 DeQuervain tenosynovitis cases were enrolled in a prospective, nonrandomized clinical trial from 2012 to 2016. At enrollment they were offered the option of Omegaplasty as a surgical treatment modality for their cases. The procedure is based on liberating the anterior attachment of the pulley from the anterior lip of the styloïd process while respecting its continuity with the periosteal flap as well as promoting expansion of the tunnel volume. All operated patients were evaluated using the “Opposition Kapandji Score”.

Results: The authors present the results of 29 different “Omegaplasty” procedures. Based on the Kapandji opposition score, twenty cases scored 10/10 while the remaining nine cases yielded an 8/10 score each.

Conclusions: The described technique is simple, reliable and respects the extensor tendons gliding physiology and biodynamics. By preserving the anatomical continuity of the first extensor compartment pulley at the wrist, the risk of adhesion formation is reduced. The preliminary results are encouraging and provide the “Ω” plasty the potential to be considered as a surgical option for treatment of De Quervain Tenosynovitis.

Numerous surgical approaches have been described for treating patients suffering with stenosing tenosynovitis. The usual surgical descriptions differ mainly by the type of skin incision utilized. The goal of surgery is to completely release the A1 pulley, thereby allowing unimpeded motion of the flexor tendons. We describe a minimally invasive endoscopic technique to address this condition in the fingers.

Background: De Quervain tenosynovitis (DQT) has been associated with repetitive movements of the radial first dorsal compartment. Since 2007, smartphones have become ingrained in society. Their functionality is primarily performed by dexterity of the user’s thumb(s). The aim of this study was to review the current literature regarding the correlation between DQT and smartphone usage as a systematic review has not previously been presented.

Methods: A literature review was conducted electronically using the EMBASE, PubMed, Cochrane and MEDLINE search libraries during May of 2019. Studies eligible for inclusion were English-language studies assessing the link between mobile phone use and DQT. Included studies were required to report on focused outcomes. Only original data studies were included. Case studies, those with data sets collected prior to 2007, foreign language research were excluded.

Results: A positive Finkelstein’s result within the cohorts was found in a mean of 51.54% of participants. Odds ratios (OR) of 1.5 to 2.3 were found with increasing frequency of text messages and DQT. Females were found to have a higher frequency of text messages daily. Internet browsing and gaming on mobile phones were associated with an OR of 2.21 and 2.61 respectively. DQT associated pain correlated to a mild disruption in daily tasks. On a visual analogue scale, this pain was represented as a 4 out of 10.

Conclusions: In conclusion, there appears to be a linear association between frequency of text messages and incidence of DQT. Additionally, there is an association between DQT pain and a mild disruption to daily activities other than mobile phone use.

Background: Amyloidosis treatment has advanced rapidly along with the discovery of drugs to prevent amyloid deposition. Therefore, it is vital to detect amyloidosis at an early stage. Wild-type transthyretin, which can cause carpal tunnel syndrome, may also cause finger tenosynovitis. However, the correlation between wild-type transthyretin amyloid and finger tenosynovitis is unclear. Here, we investigated pathological and clinical findings for 20 patients with finger tenosynovitis who underwent operation at our hospital to determine the frequency of transthyretin amyloid deposition in idiopathic finger tenosynovitis.

Methods: To check for the presence of amyloid deposition, all specimens (tendon synovium tissue or flexor tendon sheath) resected during the operation were stained by the direct fast scarlet method. Amyloid-positive specimens were evaluated by immunohistochemical staining using an anti-transthyretin antibody. Patient characteristics were evaluated with respect to amyloid presence.

Results: Thirteen (65%) of 20 finger tenosynovitis cases had amyloid deposition. Nine (69.2%) of the 13 amyloid-positive cases exhibited extensive transthyretin staining and were considered to have transthyretin amyloid. Amyloid deposition was more frequent in men. The mean number of fingers with tenosynovitis was significantly higher in amyloid-positive cases (3.8 fingers) than in amyloid-negative cases (2.0 fingers).

Conclusions: Men with multiple finger tenosynovitis tended to have transthyretin amyloid deposition. Our results support that multiple finger tenosynovitis may serve as an initial indication of evaluation for transthyretin amyloidosis.

Eosinophilic fasciitis (EF) is a rare form of fibrosing disorder associated with peripheral eosinophilia with scleroderma-like skin induration and fasciitis in the extremities resulting in painful swelling, erythema and progressive contracture. We present a case report of EF and a literature review to raise awareness of this unusual condition and also highlight key features in its management.

Background: Trigger digit(s) (TD) is one of the most common disorders of the hand in the elderly population. The aim of this study is to determine the prevalence and identify the risk factors for TD in an elderly Japanese population.

Methods: We randomly sampled 1,297 subjects between the ages of 50 and 89 years from the population registry of a town in Japan. About 413 subjects agreed to participate in the study, and all were examined for the presence of TD. Subjects were divided into three groups namely history of treatment for TD in the past (PTD), current evidence of TD (CTD) or both (BTD). The prevalence of TD was weighted by age according to the composition of the Japanese population. Age, female gender, obesity, hard manual work, exposure to vibration tools, sports activity, smoking, alcohol, wrist fracture, hypertension, hypothyroidism, diabetes mellitus, rheumatoid arthritis and carpal tunnel syndrome were assessed as risk factors for TD using univariate and multivariate logistic regression analysis.

Results: Forty subjects had TD. This included 18, 19 and 3 subjects with PTD, CTD and BTD, respectively. The weighted prevalence of TD was 9.7% (female, 14.3%; male, 4.4%) in the Japanese population aged 50–89 years. Age 70–79 and female gender were identified as risk factors for TD.

Conclusions: The random sampling of a Japanese population registry between the ages of 50 and 89 years revealed the prevalence of TD as 9.7% and identified age between 70 and 79 and female gender as risk factors for developing TD.

Level of Evidence: Level II (Therapeutic)

A persistent infective tenosynovitis, caused by a non-pathogenic Neisseria species and involving the little finger and the thumb of a middle-aged woman, forming a horseshoe-type infection is presented. An extensive volar approach was utilised for excision of the granulomatous synovium and drainage of turbid fluid. Neisseria spp was isolated by tissue microbiology and targeted antibiotic therapy for 6 weeks was required to eradicate infection. The presence of low virulence microorganisms which might act as true pathogens should always be considered as a causative factor leading to persistent infections that require open surgical debridement and washout.

Level of Evidence: Level V (Therapeutic)