Download PDF
CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2023; 51(01): e048-e055
DOI: 10.1055/s-0043-1769605
Surgical Technique

Arthroscopy and Tenoscopy in the Treatment of 6th Compartment Tenosynovitis: Technical Description and Series of Patients

Article in several languages: español | English
Ricardo Kaempf de Oliveira
1   Departamento de Cirugía de la Mano, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
,
João Pedro Farina Brunelli
1   Departamento de Cirugía de la Mano, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
,
Márcio Aita
3   Departamento de Cirugía de la Mano, Faculdade de Medicina do ABC, Santo André, Brasil
,
Pedro J. Delgado
4   Departamento de Cirugía de la Mano, Unidad de Cirugía de la Mano, Hospital Universitário Madrid Montepríncipe, Universidade CEU San Pablo, Boadilla del Monte, Madri, Espanha
,
Elisa De Torres-De Torres
5   Departamento de Ortopedia y Traumatología, Unidad de Cirugía de la Mano, Hospital Universitario de Móstoles, Madrid, Spain
,
Fernando Corella
2   Departamento de Cirugía, Unidad de Cirugía de la Mano, Hospital Universitario Quirónsalud Madrid, Universidad Complutense de Madrid, Madrid, Spain
› Author Affiliations Declaration of Funding This study did not receive any financial support for developing this work.
› Further Information
   Permissions and Reprints

Abstract

We call tenoscopy the procedure where an endoscopic approach to tendon sheaths is performed. It has already been described for the treatment of ankle, elbow, shoulder, wrist, and hand disorders. We have treated with tenoscopy a series of eight wrists in six patients with chronic inflammatory processes of the sixth extensor compartment of the wrist with no improvement with initial conservative treatment. The procedure begins with an arthroscopy of the radiocarpal and midcarpal spaces to rule out other intra-articular causes of ulnar-sided pain in the wrist. Then, through the 6R portal, the capsule, and the deep portion of the sheath of the extensor carpi ulnaris are resected, gaining access to the inside aspect of the sixth compartment. With the full view of the inner sixth compartment, a specific portal is created for the extensor carpi ulnaris located two centimeters proximal to the joint. Then a wide synovectomy of the compartment is performed with a shaver, both proximal and distal to the joint. The dorsal sensitive branch of the ulnar nerve remains safe throughout the procedure. We have performed a tenoscopy of the sixth extensor compartment in eight wrists of six patients who had failed conservative treatment and obtained great improvement of symptoms with the procedure, with no serious complications or lesion recurrence. Tenoscopy of the extensor carpi ulnaris allows synovectomy of the sixth extensor compartment, preserving the extensor retinaculum. With a minimally invasive approach, this procedure causes less local damage to soft tissues, with less scar tissue formation when compared with classic open procedures. By using a clear view of the compartment through tenoscopy, the risk of adhesions and injury to the ulnar extensor tendons is decreased.

Keywords

wrist pain - extensor carpi ulnaris - tenosynovitis - wrist ulnar-sided pain - arthroscopy portals - wrist arthroscopy complication

Declaration of Ethical Approval

The present study was submitted and approved by the Ethics Committee of our Institution.


Informed Consent Statement

There is no information (names, initials, hospital identification numbers, or photographs) in the submitted manuscript that could be used to identify the patients.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with institutional and/or national research committee ethical standards and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards.




Publication History

Received: 15 October 2022

Accepted: 07 March 2023

Article published online:
07 June 2023

© 2023. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Bibliografía

  • 1 Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39 (09) 837-857
    CrossrefPubMedGoogle Scholar
  • 2 Vuillemin V, Guerini H, Bard H, Morvan G. Stenosing tenosynovitis. J Ultrasound 2012; 15 (01) 20-28
    CrossrefPubMedGoogle Scholar
  • 3 Eo S, Bahk S, Jones NF. Wrist pain due to abnormal extensor carpi ulnaris tendon. Vol. 43, Archives of Plastic Surgery. Korean Society of Plastic and Reconstructive Surgeons; 2016: 389-390
    Google Scholar
  • 4 Hajj AA, Wood MB. Stenosing tenosynovitis of the extensor carpi ulnaris. J Hand Surg Am 1986; 11 (04) 519-520
    CrossrefPubMedGoogle Scholar
  • 5 Sanmartín-Fernández M, Couceiro-Otero J, Costas-Alvarez M, Sotelo-Garcia A. Extensor carpi ulnaris tenosynovitis caused by the tip of an oversized ulnar styloid: a case report. J Wrist Surg 2015; 4 (01) 65-67
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Bortolotto C, Draghi F. Rupture of the sheath of the extensor carpi ulnaris tendon in a patient affected by rheumatoid arthritis. Journal of Ultrasound. Springer Science and Business Media; 2016: 77-79
    Google Scholar
  • 7 Inoue G, Tamura Y. Surgical treatment for recurrent dislocation of the extensor carpi ulnaris tendon. J Hand Surg [Br] 2001; 26 (06) 556-559
    CrossrefPubMedGoogle Scholar
  • 8 Montalvan B, Parier J, Brasseur JL, Le Viet D, Drape JL. Extensor carpi ulnaris injuries in tennis players: a study of 28 cases. Br J Sports Med 2006; 40 (05) 424-429 , discussion 429
    CrossrefPubMedGoogle Scholar
  • 9 Lui TH. Extensor Tendoscopy of the Wrist. Arthrosc Tech 2016; 5 (04) e751-e756
    CrossrefPubMedGoogle Scholar
  • 10 Lui TH. Flexor Pollicis Longus Tendoscopy. Arthrosc Tech 2017; 6 (01) e249-e254
    CrossrefPubMedGoogle Scholar
  • 11 Lui TH. Endoscopic Ganglionectomy of Palmar Ganglion via Flexor Carpi Radialis Tendoscopy. Arthrosc Tech 2017; 6 (05) e1459-e1463
    CrossrefPubMedGoogle Scholar
  • 12 Lui TH, Lau AYC. Endoscopic Ganglionectomy and Release of the Sixth Extensor Compartment. Arthrosc Tech 2019; 8 (02) e111-e115
    CrossrefPubMedGoogle Scholar
  • 13 Omokawa S, Gumpangseth T, Komutrattananont P, Inchai C, Mahakkanukrauh P. Anatomical Study of Stabilizing Structures of the Extensor Carpi Ulnaris Tendon Around the Wrist. J Hand Surg Am 2021; 46 (10) 930.e1-930.e9
    CrossrefPubMedGoogle Scholar
  • 14 Barfred T, Adamsen S. Duplication of the extensor carpi ulnaris tendon. J Hand Surg Am 1986; 11 (03) 423-425
    CrossrefPubMedGoogle Scholar
  • 15 Allende C, Le Viet D. Extensor carpi ulnaris problems at the wrist–classification, surgical treatment and results. J Hand Surg [Br] 2005; 30 (03) 265-272
    CrossrefPubMedGoogle Scholar
  • 16 Nakashima T, Hojo T, Furukawa H. Deep and shallow forms of the sulcus for extensor carpi ulnaris. Vol. 183. J Anat 1993
    PubMedGoogle Scholar
  • 17 Iorio ML, Bayomy AF, Huang JI. Morphology of the extensor carpi ulnaris groove and tendon. J Hand Surg Am 2014; 39 (12) 2412-2416
    CrossrefPubMedGoogle Scholar
  • 18 Ghatan AC, Puri SG, Morse KW, Hearns KA, von Althann C, Carlson MG. Relative Contribution of the Subsheath to Extensor Carpi Ulnaris Tendon Stability: Implications for Surgical Reconstruction and Rehabilitation. J Hand Surg Am 2016; 41 (02) 225-232
    CrossrefPubMedGoogle Scholar
  • 19 Lillegraven S, Bøyesen P, Hammer HB. et al. Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis. Ann Rheum Dis 2011; 70 (11) 2049-2050
    CrossrefPubMedGoogle Scholar
  • 20 Kakar S, Garcia-Elias M. The “four-Leaf Clover” Treatment Algorithm: A Practical Approach to Manage Disorders of the Distal Radioulnar Joint. Journal of Hand Surgery. W. B. Saunders; 2016: 551-564
    Google Scholar
  • 21 de Torres-de Torres E, Hernández MO, Corella Montoya F. Visualization of the extensor carpi ulnaris and its subsheath using standard wrist arthroscopy. Journal of Hand Surgery: European Volume. SAGE Publications Ltd; 2021: 208-209
    Google Scholar