Reoperative Tenosynovitis

  • Steven C. HaaseEmail author
  • Kevin C. Chung


Recurrent tenosynovitis about the hand and wrist fortunately is an uncommon problem. For stenosing tenosynovitis, the usual culprit for continued symptoms is incomplete release. At this point, the appropriate surgery is to repeat the release and make sure that there are no further constricting points about the flexor tendon sheath. Of course, the A2 pulley needs to be preserved and protected, but the A0 and A1 pulleys should be thoroughly released. The other condition discussed is deQuervain’s tenosynovitis. The most common reason for failure of this surgery is a hidden slip of tendon in a separate compartment that was not released. Other potential causes include tendon subluxation about the radial styloid. Reoperative options in these scenarios include decompressing all of the tendons and making sure no tendons are left in any separate compartments. For tendon subluxation, a slip of the brachioradialis tendon can be used to reconstruct the retinaculum. Ultimately, if the patient still has symptoms that cannot be completely explained, but continue to appear to be deQuervain’s tenosynovitis, a slip of tendon can be resected, thereby decreasing the cross-sectional area going through the first dorsal compartment. In general, the harder part of these cases is trying to reassure the patient that despite what is normally viewed as an “easy” surgery, technical challenges do occur and fortunately in most cases reoperative surgery in these situations does provide improvement in the patient’s symptomatology.


Tenosynovitis deQuervain’s Trigger Finger Tendinosis 


  1. 1.
    Ferlic DC. Rheumatoid flexor tenosynovitis and rupture. Hand Clin. 1996;12(3):561–72.PubMedGoogle Scholar
  2. 2.
    Williamson SC, Feldon P. Extensor tendon ruptures in rheumatoid arthritis. Hand Clin. 1995;11(3):449–59.PubMedGoogle Scholar
  3. 3.
    Wilson RL, DeVito MC. Extensor tendon problems in rheumatoid arthritis. Hand Clin. 1996;12(3):551–9.PubMedGoogle Scholar
  4. 4.
    Fitzgerald BT, Setty A, et al. Gout affecting the hand and wrist. J Am Acad Orthop Surg. 2007;15(10):625–35.PubMedGoogle Scholar
  5. 5.
    Mateo L, Rufi G, et al. Mycobacterium chelonae tenosynovitis of the hand. Semin Arthritis Rheum. 2004;34(3):617–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Cucurull E, Sarwar H, et al. Localized tenosynovitis caused by Histoplasma capsulatum: case report and review of the literature. Arthritis Rheum. 2005;53(1):129–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Fitzpatrick DC, Jebson PJ, et al. Upper extremity musculoskeletal manifestations of dialysis-associated amyloidosis. Iowa Orthop J. 1996;16:135–8.PubMedGoogle Scholar
  8. 8.
    Carlson JA, Wei-Lee H, et al. Sarcoidal granulomatous tenosynovitis of the hands occurring in an organ transplant patient. J Cutan Pathol. 2007;34(8):658–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Ahuja NK, Chung KC. Fritz de Quervain, MD (1868-1940): stenosing tendovaginitis at the radial styloid process. J Hand Surg Am. 2004;29(6):1164–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Peters-Veluthamaningal C, van der Windt DA, et al. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009;(1):CD005617.Google Scholar
  11. 11.
    Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg Am. 2006;31(1):135–46.CrossRefPubMedGoogle Scholar
  12. 12.
    Ilyas AM, Ast M, et al. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757–64.PubMedGoogle Scholar
  13. 13.
    Hanlon DP, Luellen JR. Intersection syndrome: a case report and review of the literature. J Emerg Med. 1999;17(6):969–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Bae DS, Sodha S, et al. Surgical treatment of the pediatric trigger finger. J Hand Surg Am. 2007;32(7):1043–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Backhaus M. Ultrasound and structural changes in inflammatory arthritis: synovitis and tenosynovitis. Ann N Y Acad Sci. 2009;1154(1):139–51.CrossRefPubMedGoogle Scholar
  16. 16.
    McQueen FM. The MRI view of synovitis and tenosynovitis in inflammatory arthritis: implications for diagnosis and management. Ann N Y Acad Sci. 2009;1154:21–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Ramesh R, Britton JM. A retinacular sling for subluxing tendons of the first extensor compartment. A case report. J Bone Joint Surg Br. 2000;82(3):424–5.CrossRefPubMedGoogle Scholar
  18. 18.
    McMahon M, Craig SM, Posner MA. Tendon subluxation after de Quervain’s release: treatment by brachioradialis tendon flap. J Hand Surg Am. 1991;16(1):30–2.CrossRefPubMedGoogle Scholar
  19. 19.
    El Rassi G, Bleton R, Laporte D. Compartmental reconstruction for de Quervain stenosing tenosynovitis. Scand J Plast Reconstr Surg Hand Surg. 2006;40(1):46–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Section of Plastic SurgeryUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Department of SurgeryUniversity of Michigan Health SystemAnn ArborUSA

Personalised recommendations