• Clinical Pain
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• v.20 no.1
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• pp.20-24
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• 2021

In this case report, we present a rare case of lipoma of the tendon sheath localized to the wrist which caused median entrapment neuropathy and was successfully treated with surgical excision. Dynamic examination using ultrasonography revealed the exact location of the lipoma. Electrodiagnostic study (EDX) was done before surgery to elucidate combined neuropathy, and surgery for ulnar neuropathy around elbow was also performed simultaneously. Diagnostic ultrasound can be used for dynamic examinations with real-time visualization.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.516-518
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• 2009

Purpose: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal - incision tenorrhaphy using 1 cm - length incision and minimal dissection. Methods: Transverse incision about 1 cm - length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. Catheter is sutured to proximal tendon in end - to - end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. Results: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. Conclusion: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.

• The Journal of the Korean bone and joint tumor society
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• v.7 no.1
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• pp.20-27
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• 2001

Purpose : The giant cell tumor of tendon sheath is the second most common tumor of the hand, but recurred frequently although excision was performed. Authors analyzed and would report clinical findings and postoperative results of it. Materials and Methods : Between January 1991 and December 1998, 38 patients, 41 cases which the authors had performed excisional biopsy to the mass in the hand and diagnosed with the giant cell tumor of tendon sheath, was analyzed with age, sex, chief complaint, symptom duration, involved finger, involved tendon, frequently developed site in fingers, size, multiplicity, radiologic findings and recurrence. The mean duration of follow-up was 13.1 months (5~40 months). Results : Of 38 patients, twenty-nine were female. It is frequent in the fourth decade and mean age was 40.1 years old. The neurological compression symptom was found in 5 cases. The mean duration of symptom was 23.4 months. Flexor tendon was involved in 24 cases. The distal interphalangeal joint area in digit was involved most frequently in 20 cases. Index finger was the most common involved finger (14 cases), and long finger was the second most common (9 cases). All tumors were unilateral. The majority of patients had solitary lesion but one case had multiple lesion. In the radiologic findings, erosion or pressure indentation of bone was seen in 3 cases. All patients were operated by marginal excision. Recurrence rate was 5.1%. Conclusion : The risk factors in giant cell tumor of tendon sheath were female, forth decade, index finger, flexor tendon, and distal interphalangeal joint area. The recurrence was increased in marginal excision of recurred cases, in cases with multiple developed lesions or in multilobular lesion, so wide surgical excision is necessary to prevent recurrence.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2003.03a
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• pp.23-23
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• 2003

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.796-798
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• 2007

Purpose: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free. Methods: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a $1.6{\times}1.3cm$ sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern. Results: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. Conclusion: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.

• Journal of Veterinary Clinics
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• v.33 no.1
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• pp.1-5
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• 2016

Septic tenosynovitis of the digital flexor tendon sheath (DFTS) is a potentially career-ending and life-threatening problem in horses. This study aimed to describe the outcomes of tenoscopy for the treatment of acute septic digital flexor tenosynovitis in horses. Tenoscopy was performed on 13 Thoroughbred horses with acute septic tenosynovitis of the DFTS. Surgical time was 56-148 min (mean 85.6 min, median 84.0 min). In the synovial fluid analysis, mean white blood cell count, mean neutrophil proportion, and mean total protein were $42.9{\times}10^3cells/{\mu}l$ (range, $7.2-109.5cells/{\mu}l$), 89.5% (range, 68-97%), and 4.0 g/dl (range, 2.5-5.2 g/dl), respectively. Microbial growth in the synovial fluid culture was detected in 2 of 11 horses. All horses survived and returned to their intended use without complications. The present study demonstrated that the tenoscopy is useful for treating acute septic tenosynovitis of the DFTS in horses.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.52-60
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• 2003

Purpose: To analyse their end results and also to differentiate the single or multiple giant cell tumor(GCT) of tendon sheath in hand. Materials & Methods: Total 21 cases with GCT of tendon sheath in hand were treated surgically and analyzed their end results with clinically, radiologically and pathologically to allowed for average 16 months after surgical excision. Results: The finger flexor tendons, especially on index and ring finger, involving distal interphalangeal joint and mid-phalanges in fourth decades (average age of 47 years old) were frequently involved, and the mass was not exceed than 2 cm in size, fixed on tendon sheath with rubbery hard tenderness but rare bony involvements except 4 cases of bony erosion and cortical perforation. The three cases with multiple GCT of hand was also combined with familial hypercholesterolemia, and are commonly involved the extensor tendons as well as achilles tendons bilaterally, treated with partial excision because of multiplicity. Average 16 months after surgical excision for single GCT cases was followed and showed the recurrence in 3 cases(3/18,16.7%), treated with wide excision. The single and multifocal GCT are similar in pathologic changes but different soft tissue tumors in their pathogenesis, treatment and prognosis. Conclusion: Incomplete excision of GCT of tendon sheath in hand are thought to be the cause of recurrence, especially in cases with incomplete lesional excision, in multilobular and bony involvement etc. So careful wide excision is necessary to prevent the recurrence.

• Archives of Plastic Surgery
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• v.32 no.2
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• pp.259-261
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• 2005

Ganglion is the most common soft tissue tumor of the hand, and most of them usually arise from the scapholunate ligament, scarphotrapezial ligament, radiocarpal joint or flexor tendon sheath. However, intratendinous ganglion is very rare with unknown etiology and pathogenesis that originates within tendon. We have experienced three clinical cases of intratendinous ganglion in extensor tendons of hand. The average of patients at operation was 36 years. All patients were treated by excision of the ganglion in conjunction with tenosynovectomy followed by repair of the tendon. The length of mean follow up time was 6.7 months and all of them showed no evidence of recurrence.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.329-334
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• 2010

Purpose: Adhesion after flexor tendon injury is a result of fibrosis between tendon and tendon sheath. This, finally interfere with gliding mechanism of tendon and results in functional problem of hands. Therefore, there have been many trials to reduce adhesion around the tendon. However, there is no standard procedure clinically practiced in hospitals. Mitomycin-C is an antineoplastic alkylating agent that decrease fibroblast proliferation and scar formation. It is commonly used in many surgery to reduce postoperative adhesion. This study was designed to observe the effect of Mitomycin-C on preventing adhesion in injured flexor tendon. Methods: The deep flexor tendon of digit 2 and 4 in the left forepaw of 15 New Zealand White rabbits were subjected to partial tenotomy. In study group, injury site was exposed to a single 5-minute application of Mitomycin-C, and in control group was left untreated. Digit 2 and 4 in the right forepaw of each rabbit were considered as nonadhesion control group. After 2 weeks, the animals were sacrificed and digits were amputated for biomechanical test and histological study. Results: In biomechanical study to measure yield point, mean yield point of non-adhesion control was $17.43{\pm}2.33$ and $25.07{\pm}4.03$ for adhesion control, which proves increase of adhesion in adhesion control group (p<0.05) in 95% confidence. In Mitomycin-C group, mean yield point was $12.71{\pm}4.97$. Compared with adhesion control, there was decrease in adhesiveness in Mitomycin-C group (p<0.05) in 95% confidence. In histological study, the result of adhesion control revealed massive adhesions of bony structure, fibrotic tissue and tendon structure with ablation of the border. However in Mitomycin-C group, we could find increased fibrotic tissue, but adhesion is much lesser than adhesion group and borders between structures remain intact. Conclusion: This study suggests that Mitomycin-C can significantly reduce adhesion of injured flexor tendon in rabbit model.

• Archives of Plastic Surgery
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• v.49 no.6
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• pp.750-754
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• 2022

Trigger wrist, characterized by a clicking or snapping sensation around the wrist joint during finger or wrist motion, and bifid or trifid median nerve, which occurs in carpal tunnel syndrome along with anatomical variation of median nerve, are rare conditions. We report the case of a patient with a thickened tendon caused by severe tenosynovitis and flexor tendon subluxation to the hamate hook due to bowing of the flexor retinaculum, thereby resulting in trigger wrist as well as an anatomical median nerve variation (bifid median nerve in the right wrist and trifid median nerve in the left wrist). A 59-year-old housewife visited our hospital with bilateral fingertip numbness, tingling sensation, and aggravated severe night cramping that began 2 months ago. She also complained about trigger wrist during small finger flexion. Based on magnetic resonance imaging, ultrasonography, and nerve conduction study, trifid median nerve and bilateral severe median nerve neuropathy of the wrist were diagnosed; therefore, transverse carpal tunnel release and exploration under wide-awake anesthesia were planned. Intraoperative findings showed trifid and bifid median nerves in left and right wrists, respectively. Additionally, bowing of flexor retinaculum and severe flexor tendon tenosynovitis were observed. Tenosynovitis with thickened flexor sheath resulted in subluxation of the small finger flexor tendon above the hamate hook. After transverse carpal ligament release with antebrachial fascia release and tenosynovectomy, subluxation of the flexor tendon was resolved. At 6 months postoperatively, the tingling and dullness in fingertips also resolved, and no trigger wrist or any other complications were noted.