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Idiopathic Extensor Digitorum Communis Stenosing Tenosynovitis: A Case Series of 60 Wrists
Parisun Shoga, DO
1, Kelly N McKnight, MD
2, Deborah C Bohn, MD
3; Christina M. Ward, MD
1(1)University of Minnesota, Minneapolis, MN, (2)Avera Health, Sioux Falls, SD, (3)Orthopaedics, University of Minnesota, Minneapolis, MN
IntroductionTenosynovitis of the fourth dorsal compartment can cause pain, swelling, limited active wrist extension, and may even lead to tendon rupture. This condition is well described in patients with rheumatoid arthritis; its etiology in this setting is secondary to inflammation, fluid production, and synovial tissue hypertrophy and invasion. However, tenosynovitis of the fourth dorsal compartment may also occur in patients without a history of inflammatory arthritis, but current literature on this topic is limited. In many of these patients, there appears to be mechanical impingement of the extensor digitorum communis (EDC) tendons on the thickened extensor retinaculum. The purpose of this study is to describe the findings and results associated with idiopathic EDC stenosing tenosynovitis.
Materials & MethodsThis is a retrospective review of a consecutive series of patients treated for EDC stenosing tenosynovitis at a single institution from January 1, 2010 through June 30, 2022. Patients greater than 18 years old who underwent surgical treatment for idiopathic EDC stenosing tenosynovitis were included in our study. Patients with inflammatory arthritis (ie rheumatoid arthritis) were excluded. Data collected included: age, gender, duration of symptoms, history of injury, laterality, hand dominance, history of rheumatoid arthritis of inflammatory condition, history of splint immobilization, history of oral anti-inflammatories used, history of previous cortisone injection, grip strength, imaging results, operative reports, histology results, range of motion, and subjective improvement after surgery.
Results60 wrists in 59 patients were included in this study. There were 25 male (42.3%) and 32 female (54.2%) patients in our series with an average age of 55.4 years old. An MRI was completed in 27 wrists and demonstrated most patients with varying degrees of tendinopathy and tenosynovitis. A tenosynovectomy was performed in all 60 wrists. Intraoperative findings demonstrated tenosynovitis, ganglion cysts, and both partial and complete tendon ruptures. A specimen sent to pathology at the time of surgery for 47 wrists and examined for inflammatory reaction. Of the 47 pathology specimens sent, 22 wrists (46.8%) were found to have an inflammatory reaction in their histologic slides whereas 25 wrists (53%) did not. Most patients (91.6%) reported improvement after surgery.
ConclusionsIdiopathic EDC stenosing tenosynovitis results in pain, swelling, limited active wrist extension, and may even lead to tendon rupture. This study describes the characteristics of findings in 59 patients with idiopathic EDC stenosing tenosynovitis.
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