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

Part II Studies on the surgical treatment of tendon lesions in the rheumatoid hand

Abstract

Among a series of 78 cases of rheumatoid tenosynovitis 22 cases (26 hands) were surgically treated. Tenosynovectomy was performed in 21 hands (dorsal wrist in 15 hands, volar wrist in 2 hands, digital flexors in 12 fingers of 6 hands) and reconstructive surgeries using tendon transfer or tendon grafting combined with tenosynovectomy were done in 4 hands (dorsal wrist in 3 hands, one hand in volar wrist) and a reconstruction using tendon transfer only was done in one hand with dorsal wrist.
Intermediate follow-up study in an average follow-up of 20.5 months was perfomed on 14 cases of tenosynovectomies (10 hands of dorsal wrist,2 hands of volar wrist,10 fingers of digital flexors) and also a study of an average of post-operative observation of 21.8 months was done on 5 cases in which reconstructive surgeries (tendon transfer for extensor tendon rupture in 4 hands, long bridge free tendon graft for flexor tendon rupture in one hand) were performed.
The follow-up results of tenosynovectomies were evaluated by the criteria set up by the author as discribed below. Improvement: inflammatory signs subsided, finger function improved or not changed. No change: inflammatory signs subsided, but finger function worsened. Worsening: inflammatory signs reduced, but remained, finger function not changed or worsened.
Among the cases of extensor tenosynovitis,“Improvement”was seen in 12,“No change”in 0 and“Worsening”in 0. Flexor tenosynovitis in volar wrist presenting carpal tunnel syndrom was improved in 2, no change in 0 and worsened in 0. Among 10 fingers of digital flexor tenosynovitis 7 were improved,3 showed no change and no cases worsened. In these 3 fingers the extension movement of the fingers is limited but the inflammatory signs are completely eliminated and daily activity is normal. No postoperative complication, for instance adhesion or rupture of the operated tendons, was found. In constructive surgery cases the results using long amplitude tendons such as indicis proprius or superficial flexor tendons were better than the results using amplitude tendon for instance extensor carpi radialis tendon. thereextensor ashort