Radial Bursa Research Articles

Irrigation and Débridement of the Thumb Flexor Sheath for Tenosynovitis—An Anatomic Study for the Optimisation of Surgical Techniques in Cadaveric Specimens

Background: Treatment of a flexor tendon sheath infection of the thumb usually involves prompt surgical irrigation and debridement (ID). There are few descriptions of this procedure despite the unique anatomy of the thumb flexor sheath. The aim of this study was to investigate thumb flexor sheath ID and explore the relevant anatomy. Methods: The current ID technique was performed on eight embalmed cadaveric hands. Coloured latex was injected into the sheath, and the surrounding region was dissected. Outcomes of interest were the distribution of latex, the success of the procedure, and the anatomy of the radial bursa. Results: Latex was successfully injected into all specimens, although A1 pulley stenosis caused significant resistance to flow. Latex filled the radial bursa (four specimens), reached the distal boundary of the transverse carpal ligament (three), or did not pass the A1 pulley (one); in addition, latex was found in the deep spaces of the hand and wrist (five specimens). The radial bursa was located at a median (range) of 33.2 (23.9–34.5) mm proximal to the carpometacarpal joint and at 7.8 (0–14.0) mm distal to the distal border of the pronator quadratus. Conclusion: These findings contribute to the existing body of knowledge on the anatomy of the thumb flexor sheath and radial bursa, and will help guide hand surgeons to perform thorough ID for infection. A modified surgical technique is presented, which may help further inform the treatment of pyogenic flexor tenosynovitis and other serious hand conditions.

Diagnostic value and interventional treatment of elbow cyst by high frequency ultrasound

To study and analyze the diagnostic value and interventional treatment value of high-frequency ultrasound for elbow cyst. From February 2018 to February 2021, the data of 60 patients with elbow cyst treated by high-frequency ultrasound interventional therapy were retrospectively analyzed, including 30 males and 30 females with an average age of (30.93±5.32) years old ranging from 20 to 54 years old. The course of disease ranged from 1 to 10 years with an average of (3.45±0.25) years. High-frequency ultrasound features of all patients were analyzed. The clinical efficacy, the occurrence of adverse events and the changes of psychological status before and after treatment were analyzed. In 60 cases of elbow cyst, the cyst size was from 6 mm×7 mm to 111 mm×60 mm. The characteristics of ultrasonic images included such as most of the morphology was regular, which was round or oval, and a few were irregular;the boundary was clear, there was a capsule wall, most of the inside of the capsule was good, no echo;when accompanied by bleeding or infection, small dense points can be seen floating;the cystic wall of the patients with long course of disease was coarser, and the internal light bands were separated, showing multilocular shape;no significant blood flow signal was observed. Final results involved olecranon bursa cysts in 19 cases, annular ligament cysts in 10 cases, radial bursa cysts in 9 cases, accessory ligament cysts in 7 cases, epidermoid cysts in 4 cases, ganglion cysts in 6 cases, nerve sheath cysts in 5 cases. After treatment, 33 cases were cured, 16 cases had obvious effect, 11 cases were improved, 0 cases were invalid. After treatment, mild adverse events occurred in 1 case, moderate adverse events in 1 case, and severe adverse events in 0 cases, with a total incidence of 3.33% (2/60). After treatment, positive affect score (38.04±1.74) was higher than that before treatment (35.92±2.34), and negative affect score (24.61±1.51) was lower than that before treatment (30.15±3.46), with statistical significance(P<0.05). High-frequency ultrasound has high diagnostic value for elbow cyst, and it has ideal effect in interventional therapy.

Flexor Pollicis Longus Tendoscopy

The deep palmar spaces of the hand include the midpalmar space, the hypothenar space, the thenar space, space of Parona, and the interdigital web spaces. There are various communications between different spaces. These communications are of clinical importance in explaining the spread of inflammatory, infectious, and even neoplasic processes that involve this region. Surgical incision and drainage of all potentially communicating spaces and compartments is mandatory in deep hand infections. The purpose of this technical note is to describe the minimally invasive approach of endoscopic drainage and debridement of the flexor pollicis longus tendon sheath, radial bursa, and thenar space.

A Rare Case of Synovial Osteochondromatosis of the Bicipital Radial Bursa

Introduction: Synovial osteochondromatosis of a bicipital radial bursa is a very rare condition. We report herein a case of synovial osteochondromatosis of a bicipital radial bursa. Presentation of Case: A 52-year-old man presented with a 20-year history of a slowly enlarging mass on the left elbow. Radiographs revealed multiple oval calcified lesions in the anterior aspect of the elbow. A mass lesion was located in the bicipital radial bursa on magnetic resonance imaging (MRI) and computed tomography (CT). Surgical resection was performed. Histological examination of the excised tissue showed that the resected nodules comprised numerous hyaline cartilage-like areas surrounded by synovial membrane, suggesting synovial osteochondromatosis of the bicipital radial bursa. At 4 years postoperatively, the clinical outcome is excellent with no recurrence. Discussion: Synovial osteochondromatosis is usually an intra-articular condition. Extra-articular involvement may thus represent a diagnostic problem. MRI and CT are helpful in diagnosing and evaluating the nature, calcification, and location of the lesion. CT was particularly useful in evaluating the location of the lesion and the calcification using CT in this case. Bicipital radial bursitis is infrequent, with few reports describing this disease, and synovial osteochondromatosis of the bicipital radial bursa is an extremely rare condition. Conclusion: A very rare case of synovial osteochondromatosis of the bicipital radial bursa was described. In the case of a gradually enlarging calcifying mass in the elbow, synovial osteochondromatosis of the bicipital radial bursa should be considered among the differential diagnoses.

Lipoma arborescens of the elbow

Lipoma arborescens (LA) is a rare non-neoplastic intra-articular lesion that most commonly affects the knee joint, especially the suprapatellar bursa. It rarely affects the elbow joint. There are a few reports of involvement of the bicipital radial bursa. We report a case of LA, with characteristic MRI features, affecting the elbow joint in a young male.

An anatomic study of flexor tendon sheaths: a cadaveric study

Previous descriptions of the pattern of communication between the digital flexor tendon sheaths have been largely based on imaging studies. An anatomic study on 12 cadaveric hands was conducted using water soluble dye and directly observed patterns of communication between the digital flexor tendon sheaths and the radial and ulnar bursae. Four out of twelve specimens (33%) demonstrated a communication between the radial and ulnar bursae. The ulnar bursa communicated with the ring finger flexor sheath in two specimens, and the index finger flexor sheath in two specimens. One hand (8.3%) showed communication between the middle finger tendon sheath and radial bursa and between the index finger flexor tendon sheath and radial bursa. These findings show a considerable level of variation in communicating patterns between the synovial sheaths of the hand and wrist. Clinicians should be aware of the possibility of variations to the classical presentation of spread of infection through the digital flexor sheaths.

Radial and ulnar bursae of the wrist: cadaveric investigation of regional anatomy with ultrasonographic-guided tenography and MR imaging

To demonstrate the anatomy of the radial and ulnar bursae of the wrist using MR and US images. Ultrasonographic-guided tenography of the tendon sheath of flexor pollicis longus (FPL) and the common tendon sheath of the flexor digitorum of the fifth digit (FD5) of ten cadaveric hands was performed, followed by magnetic resonance imaging and gross anatomic correlation. Patterns of communication were observed between these tendon sheaths and the radial and ulnar bursae of the wrist. The tendon sheath of the FPL communicated with the radial bursa in 100% (10/10) of cases, and the tendon sheath of the FD5 communicated with the ulnar bursa in 80% (8/10). Communication of the radial and ulnar bursae was evident in 100% (10/10), and presented an "hourglass" configuration in the longitudinal plane. The ulnar and radial bursae often communicate. The radial bursa communicates with the FPL tendon sheath, and the ulnar bursa may communicate with the FD5 tendon sheath.

A severe infection following endoscopic carpal tunnel release

A 59-year-old patient underwent endoscopic carpal tunnel release by Chow's two-portal technique. He developed a pyogenic tenosynovitis and an infection within the ulnar and radial bursae, an abscess in the middle palmar, thenar and Parona's space, and a pyogenic wrist arthritis. Surgical treatment included a wide exposure of the infected region, débridement, irrigation, application of a resorbable collagen sponge containing gentamicin, insertion of two drains and primary wound closure. The infection was brought under control and hand function restored.

Tenosynovitis Due to Incense

A 16-year-old girl accidentally incurred a puncture wound on an incense cone. The incense, like other ligneous materials, irritated the soft tissue and predisposed the radial bursa of the forearm to infection. The infectious organisms produced gas that was visible on roentogenographic examination. This caused concern until to Clostridia could be found in the wound. The bursal opening, secondary closure, and antibiotics produced a satisfactory result.