1
|
Feroe AG, Pulos NA, Konidis J. Retained wooden splinter migrated within a digital flexor tendon sheath: Ultrasonographic diagnosis for presurgical planning. Radiol Case Rep 2024; 19:2121-2124. [PMID: 38645542 PMCID: PMC11026931 DOI: 10.1016/j.radcr.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 04/23/2024] Open
Abstract
A 29-year-old right-handed woman presented to an outside emergency department with right small finger pain, swelling, and concern for a retained wooden splinter. Diagnosis and treatment were delayed for 2 weeks due to the inability to identify the foreign body clinically or radiographically. Ultimately, ultrasonography by a fellowship-trained specialist was used to localize the wooden splinter. It was embedded within the flexor tendon sheath but had migrated away from its initial point of entry. The patient underwent subsequent surgical extraction, irrigation, and debridement. Two weeks following surgery, she had regained full range of motion through her digit without signs of infection. This case highlights the use of diagnostic ultrasound to identify a radiolucent foreign body, such as a wooden splinter, and to guide subsequent surgical extraction.
Collapse
Affiliation(s)
- Aliya G. Feroe
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Nicholas A. Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jane Konidis
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| |
Collapse
|
2
|
Kitamura K, Suzuki R, Ishizuka S, Murakami G, Rodríguez-Vázquez JF, Yamamoto H, Abe SI. Growing stylohyoideus muscle insertion to the hyoid bone with special reference to its topographical relation to the intermediate tendon of digastricus muscle: A histological study using human fetuses. Ann Anat 2024:152246. [PMID: 38460858 DOI: 10.1016/j.aanat.2024.152246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND In adults, the intermediate tendon of digastricus muscle usually runs along the medial or lateral side of the stylohyoideus muscle insertion. To provide a better understanding of the variations, we examined the topographical anatomy of the muscle and tendon in fetuses. METHODS We examined histological sections from six early-term, 26 mid-term and six near-term fetuses (approximately 8-9, 12-18 weeks and 25-33 weeks). RESULTS At early-term, an initial sheath of intermediate tendon of digastricus muscle received the stylohyoideus muscle at the superior aspect. The muscle and tendon was distant from the hyoid. At mid-term, near the insertion to the hyoid greater horn, the stylohyoideus muscle consistently surrounded more than 2/3 of the intermediate tendon circumference. In contrast, we found no near-term specimen in which the stylohyoideus muscle surrounded the intermediate tendon. The multilayered tendon sheath was fully developed until near-term and connected to the body of hyoid by an intermuscular septum between the thyrohyoideus muscle and one or two of suprahyoid muscles. Therefore, the hyoid insertion of the styloglossus muscle was a transient morphology at mid-term. CONCLUSION The stylohyoideus muscle insertion was appeared to move from the tendon sheath to the hyoid greater horn and, until near-term, return to the tendon sheath. A fascia connecting the tendon sheath to the body of hyoid was strengthened by the suprahyoid and infrahyoid muscles. The latter muscles seemed to regulate fixation/relaxation of the intermediate tendon to the hyoid. The stylohyoideus muscle slips sandwiching the intermediate tendon might be a rare morphology.
Collapse
Affiliation(s)
- Kei Kitamura
- Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan.
| | - Ryu Suzuki
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan.
| | | | - Gen Murakami
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan; Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan.
| | | | - Hitoshi Yamamoto
- Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan.
| | - Shin-Ichi Abe
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan.
| |
Collapse
|
3
|
Nakazawa R, Dohi T, Hatsuoka Y, Kigure R, Ogawa R. Fibroma of the tendon sheath in the dorsum of the foot: A case report. JPRAS Open 2022; 35:24-28. [PMID: 36593866 PMCID: PMC9804003 DOI: 10.1016/j.jpra.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Fibroma of tendon sheath (FTS) is a rare soft tissue tumor that usually occurs in the upper extremity. Moreover, of the few cases reported in the feet, nearly all occur in the plantar region. We report the case of a large FTS in the dorsum of the left foot that grew quickly into a 4 cm-diameter lesion. The 44-year-old Japanese man noticed the tumor incidentally one year before presentation and could not recall any possible cause. Physical examination showed an elastic hard mass that spread over the third to fifth metatarsal bones. MRI showed iso-intense signals with central hypo-intensity on T1-weighted images and hypo-intense signals on T2-weighted images. Since a biopsy did not reveal any malignant findings, the lesion was excised surgically. The tumor was found to be multilocular, encapsulated, and to arise from the extensor digitorum brevis tendon. Histopathology showed scattered spindle fibroblasts and slit-like vascular structures within the dense collagenous matrix. The tumor was diagnosed on the basis of the clinical, demographic, surgical, and histopathological findings as an FTS arising from the extensor digitorum brevis tendon. A review of the literature revealed seven cases of FTS of the dorsum of the foot, which indicates its rarity. More than one-half of these cases were from Japan. While the cause of FTS remains unclear, trauma has been implicated. We suggest that the cultural background of the patient, which could promote kneeling-induced dorsal foot trauma, may have contributed to the onset/progression of our case. Level of Clinical Evidence: 4.
Collapse
Affiliation(s)
| | - Teruyuki Dohi
- Corresponding author at: Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8603, Japan.
| | | | | | | |
Collapse
|
4
|
Dakkak YJ, van Dijk BT, Jansen FP, Wisse LJ, Reijnierse M, van der Helm-van Mil AHM, DeRuiter MC. Evidence for the presence of synovial sheaths surrounding the extensor tendons at the metacarpophalangeal joints: a microscopy study. Arthritis Res Ther 2022; 24:154. [PMID: 35751088 PMCID: PMC9229148 DOI: 10.1186/s13075-022-02841-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
MRI-detected inflammation around the extensor tendons of metacarpophalangeal (MCP-) joints is prevalent in RA and poses a markedly increased risk of RA development when present in arthralgia patients. Such inflammation is called 'peritendinitis' since anatomy literature reports no presence of a tenosynovial sheath at these tendons. However, the presence or absence of tenosynovium at these extensor tendons has never been studied. Therefore, an anatomical and histological study of extensor tendons at the MCP-joints of three embalmed human hands was performed. Immunohistochemical staining showed the presence of markers for synovial macrophages and fibroblast-like synoviocytes bordering a natural dorsal space next to the extensor tendon, suggesting the presence of a synovial lining. This implies that contrast-enhancement on MRI around extensor tendons at MCP-joints observed in early RA and pre-RA likely represents tenosynovitis and that inflammation of this synovial tissue is an early feature of RA.
Collapse
Affiliation(s)
- Yousra J Dakkak
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Bastiaan T van Dijk
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Friso P Jansen
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lambertus J Wisse
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
5
|
Jerome JTJ, Sofia LR, Santhi N. Recurrent Tenosynovial Giant Cell Tumor (TGCT) in Thumb Treated by Excision and Adjuvant 3DCRT Radiation. Indian J Orthop 2022; 56:1469-1473. [PMID: 35928652 PMCID: PMC9283620 DOI: 10.1007/s43465-022-00665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
UNLABELLED Tenosynovial giant cell tumors (TGCT) are benign intra-articular and soft-tissue tumors. However, they are known for recurrence in incomplete excisions and tumors adjacent to the distal joints and neurovascular structures in hand. With poor knowledge of intrinsic biology behind these clonal neoplastic tumors, wide excision and three-dimensional conformal adjuvant radiotherapy to the tumor bed significantly prevent a recurrence. We report a recurrent TGCT of the thumb around the interphalangeal joint in a 54-year-old man treated with wide excision and adjuvant three-dimensional conformal radiation therapy (3DCRT). There was no recurrence, and the patient had excellent functional outcomes at 3 years of follow-up. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00665-w.
Collapse
Affiliation(s)
- J. Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu 620017 India
| | - Loganathan Rajesh Sofia
- grid.430017.10000 0004 1766 6693Regional Cancer Center, Thanjavur, India ,Consultant GVN Hospital, Trichy, India
| | - Natesan Santhi
- Department of Biochemistry, Government Pudukkottai Medical College, Pudukkottai, India
| |
Collapse
|
6
|
Asaad SK, Bapir R, Salh AM, Abdullah AM, Tahir SH, Mikael TM, Kakamad FH, Hassan HA, Abdullah HO, Mohammed SH. Giant cell tumor of the tendon sheath in a 5-year-old child; A case report. Ann Med Surg (Lond) 2021; 69:102599. [PMID: 34429941 DOI: 10.1016/j.amsu.2021.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance: Giant cell tumors of the tendon sheath in children have rarely been reported in the literature. This study aims to present a case of giant cell tumors of the tendon sheath on the big toe of a 5-year-old child. Case presentation A 5-year-old girl presented with a painless swelling over the dorsal aspect of right big toe for 2 weeks. Physical examination revealed non-tender rubbery like swelling over the dorsal aspect of the right big toe. Ultrasound scan of the swelling showed a 17 × 7 mm oval-shaped subcutaneous hypoechoic lesion. Magnetic resonance imaging showed evidence of 20× 8 mm well-defined fusiform soft tissue lesion scalloping the bone. Under general anesthesia, the mass was totally excised. Microscopic sectioning showed a mixture of fibroblasts and histiocyte like cells associated with multinucleated giant cells in the vascular connective tissue stroma with the definite diagnosis of the giant cell tumor of the tendon sheath. Discussion These tumors mostly compose of several types of cell like synovial, siderophages, foam, inflammatory and multinucleate giant cells. The major etiological factors that induce development of this tumor could be traumatic, inflammatory, metabolic or neoplastic disease. Conclusion although it is a sporadic finding, giant cell tumors of the tendon sheath might affect the lower limb in children. Complete excision is the main modality of treatment. A giant cell tumor of tendon sheath is a painless benign soft tissue tumor. There are only a few cases that have been reported in the feet of children. In this study a case of giant cell tumor of tendon sheath in a 5-year-old child discussed.
Collapse
|
7
|
Dinç U, Şengezer E, Beger O, Yılmaz MŞ, Kurtoğlu Olgunus Z. Morphological features of the chiasma tendinum and its relation with surface landmarks and pulleys: a cadaveric study. Surg Radiol Anat 2021; 43:1623-1633. [PMID: 34196774 PMCID: PMC8455381 DOI: 10.1007/s00276-021-02783-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
Aim Chiasma tendinum (Camper’s chiasm) is of great importance in the delicate movements and stability of the fingers and takes place poorly in the literature. This study aims to reveal the morphometric details of the chiasma tendinum in relation with pulleys and other relevant structures. Materials and methods Palm and 2nd to 5th fingers of 10 (6 male, 4 female) formalin fixed cadavers were used bilaterally. After determining the superficial reference points on the fingers, the skin and the tendon sheath were incised, and then measurements of chiasma tendinum and related tendons were performed. The measurements were analyzed with respect to fingers, genders, and sides. Finally, the types of chiasma tendinum were identified and then grouped as symmetrical, asymmetrical, and pseudo chiasm. Results Pulley and chiasma tendinum positions were correlated with finger length (p < 0.01). Pulley lengths were significantly less in females. Asymmetrical chiasma tendinum types were found in 45% of the fingers. In most comparisons, values for fifth finger were significantly different than that of other fingers and chiasma tendinum types differed according to fingers and gender. The case of no fiber exchange was observed only in the 5th finger in 15%. Conclusion Findings related to the prediction of location of the pulleys and chiasma tendinum according to the superficial signs, awareness of cases where one of the two arms of the flexor digitorum superficialis is extremely thin and no fiber exchanges that may be risk factors for spontaneous tendon rupture may help provide more accurate approaches in relevant clinical applications.
Collapse
Affiliation(s)
- Uğur Dinç
- Faculty of Medicine, Justus Liebig University , Gießen, Germany. .,Department of Anatomy, Faculty of Medicine, Mersin University, Mersin, Turkey.
| | - Ecem Şengezer
- Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Merve Şehide Yılmaz
- Department of Family Medicine, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
8
|
Abstract
Background: Tenosynovial giant cell tumor (TSGCT) is the second most common benign tumor of the hand. Even though it is a benign lesion there is still a high incidence of local recurrence (range, 7%-44%) according to data in published papers. In this study, the clinical and epidemiological features of 173 patients who underwent excision of localized TSGCT, the recurrence rates and possible reasons for recurrence were examined in the light of current literature. Methods: Medical records of 173 patients with TSGCT were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Patients were asked about the recurrence of the TSGCT and the QuickDASH scoring was applied at the final clinical evaluation after mean follow-up of 81 months. Results: Females were predominantly involved (73%). Patients aged mean 44 years at the time of surgery. There were 93 tumors in flexor zones and 80 tumors in extensor zones of the hand. Of the tumors with flexor zone localization, zone II was most predominantly involved with 46 tumors, and 18 of these were on the index finger. The extensor zones III and IV were mostly involved with 9 tumors each on the middle and ring fingers. A total of 12 recurrences (6.9 %) were determined over the mean follow-up period of 81 months. Conclusions: The characteristics of our patients identified were similar to the previous studies. Surgical excision provides good outcomes in the treatment of TSGCT especially when clear margins are obtained.
Collapse
Affiliation(s)
- Hüseyin Bilgehan Çevik
- Department of Orthopaedics and Traumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sibel Kayahan
- Department of Pathology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Engin Eceviz
- Department of Orthopaedics and Traumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Seyit Ali Gümüştaş
- Department of Orthopaedics and Traumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| |
Collapse
|
9
|
Ozben H, Coskun T. Giant cell tumor of tendon sheath in the hand: analysis of risk factors for recurrence in 50 cases. BMC Musculoskelet Disord 2019; 20:457. [PMID: 31638958 PMCID: PMC6805347 DOI: 10.1186/s12891-019-2866-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/09/2019] [Indexed: 11/22/2022] Open
Abstract
Background Giant cell tumor of the tendon sheath is the most common form of giant cell tumors and is the second most common soft tissue tumor of the hand region after ganglion cyst. Magnetic resonance imaging is the diagnostic tool of choice for both diagnosis and treatment planning. The current standard treatment of choice is simple excision. The main concern about the treatment is related to the high recurrence rates. Besides incomplete excision, there is no consensus concerning the effect of other risk factors on recurrence. The literature lacks detailed reports on surgical excision of these tumors with a standardized surgical treatment and an appropriate patient follow up. The aim of this study was to investigate the recurrence rate and the associated recurrence risk factors for giant cell tumor of tendon sheath of the hand following a standardized treatment. Methods The records of patients treated for giant cell tumor of tendon sheath of the hand treated by the same hand surgeon were evaluated retrospectively. The features obtained from preoperative magnetic resonance imaging, final physical examination, patients’ age and sex, anatomical site of the tumor, relationship of the tumor with bone, joint or neurovascular structures, bone invasion, recurrence after surgery and complications like skin necrosis, digital neuropathy or limitation in range of motion were documented. Chi-square test was used to compare categorical variables. Results Fifty patient were included in the study. The average follow-up time was 84 months. Three recurrences (6%) were recorded. The only significant risk factor for the recurrence was tumor adjacency to the interphalangeal joints of the fingers other than thumb. No major or minor complications were encountered in the postoperative period. Conclusion With adequate surgical exposure and meticulous dissection provided by the magnification loupes, we were able demonstrate one of the lowest recurrence rates in the literature. Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence.
Collapse
Affiliation(s)
- Hakan Ozben
- Department of Orthopaedics and Traumatology, Hand Surgery Unit, School Of Medicine, Koc University, Davutpasa Street, No: 4 Zeytinburnu, 34010, Istanbul, Turkey.
| | - Tamer Coskun
- Department of Orthopaedics and Traumatology, Hand Surgery Unit, Koc University Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
Capkin S, Kaleli T. Superficial radial nerve compression due to fibroma of the brachioradialis tendon sheath: A case report. Acta Orthop Traumatol Turc 2019; 53:394-6. [PMID: 31031130 DOI: 10.1016/j.aott.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022]
Abstract
Fibroma of the tendon sheath (FTS) is a rare benign tumour that usually develops in the upper extremity, particularly in the fingers, hands and wrists. Herein, we present the case of a patient with an unusually localised FTS compressing the superficial branch of the radial nerve. A 62-year-old woman presented with a superficial radial nerve compression due to FTS of the brachioradialis. Histopathological diagnosis was confirmed as a FTS after marginal excision. The patient who had compression-related symptoms in the superficial branch of the radial nerve recovered completely at one month after surgery. One year later, the patient remained free of symptoms and no recurrence was observed.
Collapse
|
11
|
Kaniewska M, Steinbach LS, Neurauter U, Anderson SE. Lipidus migrans-a radiology imaging feature after ankle injury. Skeletal Radiol 2018; 47:1709-1715. [PMID: 29785451 DOI: 10.1007/s00256-018-2973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 02/02/2023]
Abstract
We present an uncommon imaging feature with fluid fat tracking within the tendon sheath of the flexor hallucis longus (FHL) after traumatic injury to the ankle joint. We propose a coined medical term "lipidus migrans" to define the presence of floating fat in a tendon sheath. This is due to lipohemarthrosis from intra-articular fracture of the ankle with leakage of fluid fat into the tendon sheath. Communication between the FHL tendon sheath and ankle joint can occur in up to 25% of patients. Radiologists should be aware of the presence of lipidus migrans as a potential posttraumatic complication after intra-articular ankle fracture and that fat in the tendon sheath may mimic fracture fragments or even a tendon sheath tumor.
Collapse
Affiliation(s)
| | - Lynne S Steinbach
- Department of Radiology, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Urs Neurauter
- Centre for Orthopaedic Surgery, Kantonsspital Aarau und Baden, Baden, Switzerland
| | - Suzanne E Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| |
Collapse
|
12
|
Takahisa O, Yasuhiro S, Shinichi S. Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk. Foot (Edinb) 2017; 31:40-43. [PMID: 28544913 DOI: 10.1016/j.foot.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/11/2016] [Accepted: 02/16/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Ogawa Takahisa
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan.
| | - Seki Yasuhiro
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan
| | - Shirasawa Shinichi
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan
| |
Collapse
|
13
|
Peters SE, Laxer RM, Connolly BL, Parra DA. Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study. Pediatr Rheumatol Online J 2017; 15:22. [PMID: 28399893 PMCID: PMC5387283 DOI: 10.1186/s12969-017-0155-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to: (a) Identify tendon sheaths most commonly treated with steroid injections in a pediatric patient population with Juvenile Idiopathic Arthritis (JIA); (b) Describe technical aspects of the procedure; (c) Characterize sonographic appearance of tenosynovitis in JIA; (d) Assess agreement between clinical request and sites injected. METHODS This was a 10 year single-center retrospective study (May 2006-April 2016) of patients with JIA referred by Rheumatology for ultrasound-guided tendon sheath injections. Patient demographics, clinical referral information, sonographic appearance of the tendon sheaths and technical aspects of the procedure were analyzed. RESULTS There were 308 procedures of 244 patients (75% female, mean age 9.6 years) who underwent a total of 926 tendon sheath injections. Ankle tendons were most commonly injected (84.9%), specifically the tendon sheaths of tibialis posterior (22.3%), peroneus longus (20%) and brevis (19.7%). The majority of treated sites (91.9%) showed peritendinous fluid and sheath thickening on ultrasound. There were 2 minor intra-procedure complications without sequelae. A good agreement between clinical request and sites injected was observed. CONCLUSIONS Ultrasound-guided tendon sheath injections with steroids are used frequently to treat patients with JIA. It is a safe intervention with a high technical success rate. The ankle region, specifically the medial compartment, is the site most commonly injected in this group of patients. The most common sonographic finding is peritendinous fluid and sheath thickening. These findings might assist clinicians and radiologists to characterize and more effectively manage tenosynovitis in patients with JIA.
Collapse
Affiliation(s)
- Shannon E. Peters
- grid.7886.1School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Ronald M. Laxer
- grid.42327.30Division of Rheumatology, Department of Pediatrics and Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| | - Bairbre L. Connolly
- grid.42327.30Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| | - Dimitri A. Parra
- grid.42327.30Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| |
Collapse
|
14
|
Verhagen MV, Chesaru I. Fat drops in wrist tendon sheaths on MRI in conjunction with a radius fracture. Skeletal Radiol 2016; 45:1129-31. [PMID: 27170371 DOI: 10.1007/s00256-016-2401-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 02/02/2023]
Abstract
A case is presented in which fat drops are seen on MRI inside extensor compartment 2 and 3, in conjunction with a radius fracture. The occurrence of traumatic tendon sheath fat-fluid levels has been sparsely reported on CT and MR imaging. This case is the first report of post-traumatic tendon sheath fat drops. Although the clinical relevance of tendon sheath fat drops seems to be limited, it is important to detect and correctly diagnose these fat drops in order to provide an accurate and complete radiologic report.
Collapse
Affiliation(s)
| | - Ileana Chesaru
- Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
| |
Collapse
|
15
|
Kerfant N, Bardin T, Roulot E. Multiple Giant Cell Tumors of the Tendon Sheath : Separate Volar and Dorsal Lesions Involving Three Digits of the Same Hand Following Repetitive Trauma. J Hand Microsurg 2015; 7:233-5. [PMID: 26078552 DOI: 10.1007/s12593-015-0185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/13/2015] [Indexed: 02/06/2023] Open
Abstract
Giant-cell tumors of the tendon sheath correspond to a localized form of pigmented villonodular synovitis. GCTTS typically occur in the hand where they represent the second most common type of soft tissue tumors after synovial ganglions. The etiology of giant cell tumors of the tendon sheath is unknown. Pathogenetic theories have included inflammatory process, trauma, immune mechanisms, neoplasia. Giant cell tumors usually present as a solitary and firm slow-growing nodular lesion, which affects the volar aspect of the hand. Multifocal lesions are rarely described in the literature and commonly involve the same finger or the volar aspect of different fingers. We report a rare case of three separate GCT occurring on both aspects of the hand thus raising the question of their etiology.
Collapse
|
16
|
Bedir R, Balik MS, Sehitoglu I, Güçer H, Yurdakul C. Giant Cell Tumour of the Tendon Sheath: Analysis of 35 Cases and their Ki-67 Proliferation Indexes. J Clin Diagn Res 2014; 8:FC12-5. [PMID: 25653956 DOI: 10.7860/jcdr/2014/10553.5311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/07/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A giant cell Tumour of the tendon sheath (GCTTS) is a slow-growing benign Tumour originating from the synovial cells of the tendon sheath. It is the second most common Tumour of the hand. The aim of this study was to perform a retrospective clinicopathological evaluation of GCTTS cases and determine whether the proliferative activity of giant cell tumour of tendon sheath is related to its recurrence rate and local aggressiveness. MATERIALS AND METHODS The age, gender, Tumour location and diameter, treatment mode, Ki-67 proliferation index, mitotic rate, and recurrence were retrospectively evaluated in 35 patients diagnosed with GCTTS in the Department of Pathology, School of Medicine, Recep Tayyip Erdogan University between 2009 and 2014. RESULTS Of the 35 GCTTS cases, 23 were female, and 12 were male. The mean age was 45 y (range 10-70). Sixteen tumours were located in the right hand and 14 in the left hand, and five were in the feet. The mean Tumour diameter was 2.3 cm (0.6-6 cm). All patients underwent marginal excision. The mean postoperative follow-up period was 4 y (range 28 months-5 y). Only six patients showed recurrence. In these cases, the site of GCTTS recurrence was the phalanx of the hand. The mean Ki-67 index in the recurrence cases was 6.5%, whereas it was 2.3% in those without recurrence. CONCLUSION The Ki-67 proliferation index and mitotic activity were increased in recurrent cases compared to nonrecurrent cases. Therefore, these parameters may be helpful in predicting recurrence of GCTTS. However, adequate surgical excision and complete removal of the Tumour are important steps to minimize the recurrence rate.
Collapse
Affiliation(s)
- Recep Bedir
- Assistant Professor, Department of Pathology, Recep Tayyip Erdogan University , Medical Faculty, Rize, Turkey
| | - Mehmet Sabri Balik
- Assistant Professor, Department of Orthopedics and Traumatology, Recep Tayyip Erdogan University , Medical Faculty, Rize, Turkey
| | - Ibrahim Sehitoglu
- Assistant Professor, Department of Pathology, Recep Tayyip Erdogan University , Medical Faculty, Rize, Turkey
| | - Hasan Güçer
- Assistant Professor, Department of Pathology, Recep Tayyip Erdogan University , Medical Faculty, Rize, Turkey
| | - Cüneyt Yurdakul
- Medical Doctor, Department of Pathology, Recep Tayyip Erdogan University , Medical Faculty, Rize, Turkey
| |
Collapse
|
17
|
Ananthi Kumarasamy S, Kannadath BS, Soundamourthy S, Subramanian A, Sinhasan SP, Bhat RV. Semimembranosus ganglion cyst. Anat Cell Biol 2014; 47:207-9. [PMID: 25276481 PMCID: PMC4178197 DOI: 10.5115/acb.2014.47.3.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/17/2014] [Accepted: 02/27/2014] [Indexed: 11/27/2022] Open
Abstract
Ganglion cysts are tumor-like lesions in the soft tissues, generated by mucoid degeneration of the joint capsule, tendon or tendon sheaths on the dorsum of hand, wrist and foot. However, an intratendinous origin for a ganglion cyst is extremely rare. During dissection of the popliteal fossa, a cyst of 2.5 cm×2 cm×0.5 cm was observed in the tendon of right semimembranosus, 3.5 cm above the insertion of the muscle. Contrast X-ray revealed the cyst as not communicating with the knee joint or any adjacent bursae. Histopathological examination confirmed the diagnosis of ganglion cyst.
Collapse
Affiliation(s)
- Suba Ananthi Kumarasamy
- Department of Anatomy, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
| | - Bijun Sai Kannadath
- Department of Anatomy, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
| | - Sandosh Soundamourthy
- Department of Anatomy, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
| | - Aruna Subramanian
- Department of Anatomy, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
| | - Sankappa P Sinhasan
- Department of Pathology, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
| | - Ramachandra V Bhat
- Department of Pathology, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
| |
Collapse
|
18
|
Sano K, Kimura K, Hashimoto T, Ozeki S. Two-stage tendon sheath reconstruction using sublimis tendon and silicone Penrose drain after severe purulent flexor tenosynovitis: a case report. Hand (N Y) 2013; 8:343-7. [PMID: 24426946 DOI: 10.1007/s11552-013-9507-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Two-stage tendon sheath reconstruction, a method of pulley reconstruction using the sublimis tendon and a pseudosheath formed with a silicone Penrose drain wrapped around the profundus tendon, is a new technique for improving a poor functional prognosis after purulent flexor tenosynovitis.
Collapse
|
19
|
Abstract
Lipomas account for approximately 16% of soft tissue mesenchymal tumours. They are uncommon in hand and those which involve the fingers are very rare, with a reported incidence of 1%. In extremities, they often arise from the sub-fascial tissues of the hands and feet, where they may be mistaken for ganglion cysts. A careful dissection is necessary during the surgical procedure, in order to avoid recurrence. Here, we are presenting the case of an 8 years old boy who had Lipoma on palmar aspect of thumb.
Collapse
Affiliation(s)
- Hemlata T. Kamra
- Associate Professor, Department of Pathology, Bhagat Phool Singh Government Medical College for women, Khanpur Kalan, Sonepat, Haryana, India
| | - Santosh L. Munde
- Associate Professor, Department of Pathology, Bhagat Phool Singh Government Medical College for women, Khanpur Kalan, Sonepat, Haryana, India
| |
Collapse
|
20
|
Ali S, Huebner S, Groshek F, Schaffer A. The floating fat sign of trauma. Can Assoc Radiol J 2013; 65:106-12. [PMID: 23850167 DOI: 10.1016/j.carj.2013.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/25/2013] [Accepted: 02/19/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA.
| | - Stephen Huebner
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Frank Groshek
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Alyssa Schaffer
- Department of Orthopedics, Temple University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
21
|
Abstract
Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons, but less frequent injuries, e.g., damage to the functional system tendon sheath and pulley or dull avulsions, also need to be considered. After clinical examination, ultrasound and magnetic resonance imaging have proved to be important diagnostic tools. Tendon injuries mostly require surgical repair, dull avulsions of the distal phalanges extensor tendon can receive conservative therapy. Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger an “intrinsic” tendon healing to guarantee a good outcome. Many substances were evaluated to see if they improved tendon healing; however, little evidence was found. Nevertheless, hyaluronic acid may improve intrinsic tendon healing.
Collapse
|
22
|
Abstract
BACKGROUND We reviewed the literature to evaluate the demographic, clinical and histological profile of giant cell tumour of tendon sheath of the digits (GCTTSD). The overall recurrence rate and the factors affecting tumour recurrence were also assessed. METHODS We searched for published articles regarding the GCTTSD in the English literature the last 30 years using the PubMed search engine. All retrieved papers were analysed and their reference lists were also screened if relevant. Clinical studies with less than five patients and follow-up less than 2 years were excluded from further evaluation. For each report, information was gathered related to trial characteristics and study population. Location and multicentricity of lesions, kind and severity of symptoms, type of applied treatment modality and histopathological features of the excised tumours were additionally recorded. A meta-analysis for estimating the pooled recurrence rate after surgical excision was also conducted. Statistical significance was assumed for p ≤0.05. RESULTS We found 21 studies with histological confirmation of GCTTS. However, only 10 studies including 605 patients were reviewed according to selection criteria (average follow-up 36.7 to 79 months). The male-to-female ratio was 1:1.47 (p < 0.005) and the mean age ranged from 32 to 51 years. Pain or sensory disturbances reported only in 15.7% and 4.57% of cases, respectively. A definite history of trauma recorded in 5% of lesions. The most frequent tumour location was the index finger (29.7%). In total, 14.8% of patients had tumour recurrence. Type I tumours (single lesions) were more frequently detected (78.7%) than type II tumours (two or more distinct tumours that were not joined together) (21.3%) but the latter were associated with a higher recurrence rate (p < 0.001). Study design also affected the possibility of recurrence as it was lower in prospective studies compared to retrospective studies (p = 0.003). Even though bone erosion was detected in 28.39%, recurrence was not more common in this group. In addition, recurrence was not significantly associated with a specific finger or phalanx. CONCLUSIONS Intrinsic biology of the tumour seems to play a more fundamental role in recurrence than tumour location or local invasiveness. More prospective well-designed studies including a large number of cases are necessary to identify tumours prone to recurrence and determine the proper treatment protocol for each individual patient.
Collapse
Affiliation(s)
- Elias Fotiadis
- Orthopaedic Department, General Hospital of Veria, Veria, Greece
| | | | | | | | - Nick P. Sachinis
- Orthopaedic Department, Interbalkan Medical Center, 10 Asklipiou Str, Pilaia, 57001 Thessaloniki, Greece
| | - Byron E. Chalidis
- Orthopaedic Department, Interbalkan Medical Center, 10 Asklipiou Str, Pilaia, 57001 Thessaloniki, Greece
| |
Collapse
|
23
|
Abstract
Recurrence of Giant cell tumor of the tendon sheath (GCTTS) is an unresolved issue, though it is a non malignant condition. The authors operated on fourteen cases of GCTTS, after fine needle aspiration cytology confirmation and using a magnifying loupe for complete excision of the lesion including the satellite nodules. In only one case recurrence was noted which was successfully managed by a second wide excision. Preoperative diagnosis and meticulous surgical technique were found the only predictive factor of recurrence. During the 5 year period from 2002, 12 patients [11 females, 1 male, mean age 29.5, ranging from 10-53 years] underwent excision of giant cell tumor of tendon sheath of the hand. The lesions were found over the thumb [n = 7], ring finger [n = 1], index finger [n = 1], and over the hand [n = 2]. The lesions were classified using the Al-Qattan classification. The most common presentation was with a mass over the hand, with a predilection to the thumb [n = 7]. Radiological changes in the form of bony indentation was seen in only 2 cases. FNAC was inconclusive in 2 out of the 12 cases. Due to the high incidence of recurrence, pre-operative planning aided by a tissue diagnosis with fine needle aspiration cytology, wide surgical exposure, and meticulous dissection with help of magnification are imperative for a successful outcome in GCTTS.
Collapse
Affiliation(s)
- S S Suresh
- Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri, 516 Sultanate of Oman
| | | |
Collapse
|
24
|
Patel S, Colaco HB, Taylor EJ. Impingement of a fibroma of the extensor tendon sheath on the extensor retinaculum. J Hand Microsurg 2010; 2:31-2. [PMID: 23129951 DOI: 10.1007/s12593-010-0005-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 11/11/2009] [Indexed: 11/26/2022] Open
Abstract
Deep lacerations to the forearm can cause impaired movement of the digits. This report describes the presentation and management of a self-harmer who presented with loss of motion of her ring finger. Surgical exploration unexpectedly demonstrated the cause to be a fibroma of the tendon sheath impinging on the extensor retinaculum. Full recovery was demonstrated at sixmonth review following removal of the lesion.
Collapse
Affiliation(s)
- Shelain Patel
- Department of Orthopaedics and Trauma, University College Hospital, 235 Euston Road, London, NW1 2BU UK
| | | | | |
Collapse
|