Management of Stenosing Flexor Tenosynovitis: Maximizing Nonoperative Success without Increasing Morbidity.

BACKGROUND: Traditional nonoperative management of stenosing tenosynovitis is limited to one corticosteroid injection, followed by surgery in the case of failure. Recently, nonoperative strategies have been extended to include two or three injections despite the absence of large prospective studies supporting this practice. METHODS: A prospective study was performed of all patients presenting with stenosing tenosynovitis to a single surgeon (R.S.R.) over a 22-year period. Patients with potentially confounding comorbidities were excluded. All digits received one to three injections of triamcinolone acetonide plus local anesthetic into the tendon sheath. Data were analyzed by digit. RESULTS: Five hundred seventy-one digits (401 patients) were included. Digits that were symptomatic for 3 months or less were more likely to resolve after one injection than those that were symptomatic for more than 3 months (OR, 2.6; 95 percent CI, 1.67 to 4.0; p < 0.01). For the digits that failed to resolve after the first injection, those that were symptomatic for 5 months or less before one injection were more likely to respond to a second injection than those that were symptomatic for more than 5 months (OR, 9.4; 95 percent CI, 3.0 to 29.7; p < 0.01). Eight digits received three injections, after which six (75 percent) achieved remission. There were no instances of tendon/pulley rupture, infection, or soft-tissue atrophy. CONCLUSIONS: Stenosing tenosynovitis is more likely to respond to nonoperative therapy when treated before 3 months. It is safe and effective to administer more than one corticosteroid injection, as second and third doses increase the overall remission rate without increasing morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The length-control suture: a new method for prevention of hypertrophic scars and dog-ears.

Surgical and traumatic wounds develop hypertrophic scarring when exposed to lengthwise stress. The length-control suture (LCS) technique, in which a suture is passed in a closed-loop beneath the wound and anchored to the underside of the dermis, thereby pulling the apices inward, protects wounds from these forces and also limits the formation of dog-ears. Between 2006 and 2009, a retrospective review was performed in 230 consecutive patients who underwent wound closure with the LCS technique by a single surgeon. Wounds were evaluated at 6 weeks and 6 months. In 223 cases (97%), the technique resulted in a scar that was thin, soft, and flat. There were 6 cases of spitting and 1 case of hypertrophy. The LCS technique is useful for a wide variety of surgical and traumatic wounds across all anatomic regions. This technique if used results in scars that are reliably flat, thin, and supple within 6 months.

Periungual myxoid neurofibroma.

A 34-year-old woman presented with a slow growing nontender nodule on her left index finger that had been present for 2 years. The tumor was excised and was histologically determined to be a myxoid neurofibroma. We report this case because of the rarity of both the tumor and its periungual location and to provide a review of the literature.