Clinico-pathological studies on the tendon lesions in the rheumatoid hand

Part 1 Studies on the incidence and clinical manifestations of tendon lesions of the rheumatoid hand

Abstract

Up till now, opinion has varied as to the question whether the incidence of tendon lesions of rheumatoid hands in the Japanese people are similar to that in western people. In order to solve this question the author made a clinical research. To make an accurate diagnosis the author collected a series of clinical symptoms for the tenosynovitis of the wrist and fingers from many reports, literature and his clinical experiences as well. Among them the following are included as important items for diagnosis: the swelling of tendon sheath, trigger and crepitus, limitation of finger motion, swelling or nodule formation of the diseased tendon, and carpal tunnel syndrome with respect to volar wrist tenosynovitis.
In this paper, reviewing 131 rheumatoid patients (definite R. A. - 3, classical R. A. - 128) the author obtained the following statistical and clinical results.1. Among 131 R. A. patients tenosynovitis in the hands was seen in 78 cases. Extensor tenosynovitis was seen in 25 cases which corresponds to 19% of all cases, flexor tenosynovitis of the volar wrist was seen in 6 cases which corresponds to 4.6% and digital flexor tenosynovitis was seen in 61 cases,46.6%. These findings mean that the incidence of tenosynovitis is not rare in our country.2. Among the inflammatory signs of tenosynovitis, swelling is most important, paticularly in its early stage, which sign tends to respond promptly to conservative treatment just the same as in synovitis of the joint. In its late stage trigger sign and crepitus become more important. The discrepancy which was obviously found in this series between the incidence of tenosynovitis of the flexor and the extensor tendons is due to the anatomical difference in the tendon and tendon sheath structure of the extensors from the flexors.3. A high incidence is seen in the digital flexor tenosynovitis of the radial three fingers probably due to more frequent usage of these three fingers. The tendon rupture was most likely to occur at the site of a bony prominence, for instance at Lister's tubercle or a dorsolateral prominence of the ulnar head. A single lesion of extensor tenosynovitis does not become a cause for severe functional disturbance which, however, does take place once the tendon is ruptured. On the other hand, in case of flexor tendons tenosynovitis is apt to invite limitation of finger joint movement resulting in finger joint contracture and also development of finger deformities.