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Abstract

Extensor tenosynovitis of the wrist can lead to rupture of the extensor tendons. Extensor tenosynovectomy is indicated if the tenosynovitis cannot be controlled by conservative measures. Open tenosynovectomy requires extensive dissection of soft tissue, including the extensor retinaculum. This article describes extensor tendoscopy of the wrist. This technique allows approach to the extensor compartments with small incisions and minimal soft tissue dissection. It is indicated when extensor tenosynovitis persists despite adequate medical treatments including medications, immobilization, and steroid injection. Synovectomy of the extensor compartments can be performed with preservation of the extensor retinaculum. This technique is contraindicated if the wrist cannot be flexed or there is severe tendinopathy of the extensor tendon that may need open reconstruction. The purpose of this technical note was to describe a minimally invasive approach of complete synovectomy of the extensor compartments with preservation of the extensor compartment.

Discussion

Extensor tenosynovitis at the wrist often is accompanied by rheumatoid arthritis, gout, trauma, mycobacterium, hyperparathyroidism, and amyloidosis induced by long-lasting hemodialysis.5 The proliferation of the tenosynovial lining can lead to impaired function owing to scarring and adhesions. It commonly presents as a mass with or without wrist pain and often leads to the limitation of range of motion.2,5,6 The ongoing tenosynovial inflammation may ultimately lead to tendon rupture, which is a serious complication that impairs hand function.1 The goal of tenosynovectomy is to limit progression of the tenosynovial proliferation to prevent subsequent tendon rupture.6 Open approach requires extensive dissection of wound and soft tissue, including the extensor retinaculum, to ensure complete synovectomy. Extensor tendoscopy of the wrist allows complete tenosynovectomy of the extensor compartment to be performed in a minimally invasive manner. It has the advantages of small switched as viewing and instrumentation portals. This allows complete visualization of the fourth compartment and its tendons.