Isolated sarcoid flexor or extensor tenosynovitis of the hand, wrist and distal forearm

Abstract

Sarcoid tenosynovitis is a rare etiology of chronic tenosynovitis of the hand. Its diagnosis is particularly challenging and must be confirmed by histopathological finding of multiple non-caseating epithelioid granulomatous lesions and giant cells. In this study, we retrospectively investigated cases with isolated sarcoid tenosynovitis of the hand undergoing only tenosynovectomy, and assessed the outcomes. Six patients were included in this study. They were referred to the clinic with painful cystic swelling of the hand/wrist/distal forearm, which was tender but not warm or red, with a continuous burning sensation, numbness and limitation of movement. Preoperative laboratory test results were normal. Ultrasound (US) showed thickened flexor or extensor tendon sheaths with multiple pockets filled with a turbid fluid. Tenosynovectomy was performed as completely as possible, sparing intact tendons, and accumulated fluids were aspirated. Outcome was assessed in terms of sensitivity, range of motion (ROM), pain on visual analogue scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and recurrence rate. At a mean follow-up period of 16.7 months, normal sensation and full ROM were restored in all patients. There was a statistically significant difference between preoperative and postoperative pain VAS and QuickDASH scores. Only two cases had recurrence, with mild pain and positive US findings; both responded well to physiotherapy and medical treatment. Isolated sarcoid tenosynovitis should be considered in the etiological diagnosis of chronic tenosynovitis of the hand. Tenosynovectomy can constitute a single treatment line. Level of EvidenceIV, therapeutic study.