Abstract: Extended tenosynovectomy could prevent spontaneous extensor tendon rupture in the rheumatoid wrist (Plastic Surgery 2015)

Saturday, October 17, 2015

Jung-Hua Hsueh, MD , Taiwan, na, Taiwan

Kuo-Chung Yang, MD , Divison of Plastic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Kuei-Chang Hsu, MD , Department of Plastic and Reconstructive Surgery, Taiwan Abstract, taipei, Taiwan

Wen-Chung Liu, MD , Department of Plastic and Reconstructive Surgery, Taiwan Abstract, taipei, Taiwan

Yen-Yi Ho, MD , Department of Plastic and Reconstructive Surgery, Taiwan Abstract, taipei, Taiwan

Cheng-Ta Lin, MD , Department of Plastic and Reconstructive Surgery, Taiwan Abstract, taipei, Taiwan

Lee-Wei Chen, MD , Department of Plastic and Reconstructive Surgery, Taiwan Abstract, taipei, Taiwan

E-Poster

Objective: Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture.

Methods: We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion.

Results: The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration >8 years, persistent tenosynovitis >1 year duration, and Larsen grade >4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis of >6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery.

Conclusion: Risk factors of spontaneous extensor tendon rupture included disease duration >8 years, persistent tenosynovitis >1 year, and wrist Larsen grade >4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy surgery to prevent more severe damage of extensor tendon should be recommended in patients who had the above risk factors.

Key Words: Extended tenosynovectomy, Larsen grade, rheumatoid arthritis, spontaneous extensor tendon rupture

28501 Extended tenosynovectomy could prevent spontaneous extensor tendon rupture in the rheumatoid wrist