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Chapter-225 Chronic Tenosynovitis

BOOK TITLE: Textbook of Orthopedics & Trauma (4 Volumes)

Author
1. Kotwal Prakash P
2. Mittal Samarth
ISBN
9789385891052
DOI
10.5005/jp/books/12869_226
Edition
3/e
Publishing Year
2016
Pages
5
Author Affiliations
1. All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, New Delhi, All India Institute of Medical Sciences (AIIMS), New Delhi, India
2. All India Institute of Medical Sciences, New Delhi, India
Chapter keywords
Tenosynovium, trigger finger, trigger thumb, splinting, corticosteroid injection, percutaneous release, open release, tendinitis, wrist flexor tendinitis, finger extensor tendinitis, radial wrist extensor tendinitis

Abstract

The tendons of the hand and wrist are normally surrounded by a tenosynovium which helps in smooth movements of the tendons in their sheaths. The patient usually presents with pain and/or inability to move the joint to its full extent. Trigger finger occurs due to narrowing of the A1 pulley of the flexor tendon sheath, causing entrapment of the flexor tendon with restriction of flexion and extension movements of the proximal interphalangeal joint (PIP). Depending on the etiology, trigger finger can either be primary or secondary. Diagnosis is based on the history and clinical presentation of pain, restricted movements of flexion and extension along with a good physical examination. The majority of the patients require either surgical or nonsurgical intervention in the form of splinting or drugs such as nonsteroidal anti-inflammatory agents (NSAIDs) or corticosteroids. Trigger thumb in adults is a different entity from congenital trigger thumb. Tendinitis, i.e. inflammation of the tendons of the wrist flexors is seen to occur either together or separately. The risk factors which predispose to this inflammation include trauma resulting in fracture of the wrist, repeated flexion or over extension of wrist.

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