title: Chronic granulomatous tenosynovitis treated with ulnar superficialis slip resection.
abstract: Ulnar superficialis slip resection is a procedure initially performed to treat flexor tenosynovitis in the rheumatoid finger. It was first described for treating trigger digits of children with mucopolysaccharide storage disorders and for more complex trigger digits in children. The procedure for adults with trigger finger was described for triggering with flexion contracture at the proximal interphalangeal joint level persisting after release of the A1 pulley and for trigger finger in diabetic patients.This article describes a case of chronic flexor tenosynovitis treated with ulnar superficialis slip resection. The patient was injured by the needle of a water pressure gauge. He developed chronic flexor tenosynovitis, and 1 year after the initial injury, surgery was performed due to a severe limitation of passive and active proximal interphalangeal joint flexion. Synovectomy was performed first, then the A1 pulley was divided. Passive finger flexion and extension was simulated and failed to reproduce full range of motion (ROM). The A3 pulley was then divided and still failed to reproduce full ROM. The ulnar slip of the flexor digitorum superficialis tendon was then resected from the distal margin of the carpal tunnel to the distal edge of the A3 pulley. The tendons could now move smoothly, and full passive ROM was achieved.Surgery consisting of synovectomy alone with or without resection of the A1 pulley without achieving full intraoperative ROM will likely lead to a poor result. We believe that cases like ours should be addressed with an "à la carte" procedure, starting with synovectomy and followed by A1 resection, A3 resection, and finally ulnar superficialis slip resection for achieving full intraoperative ROM.
authors.affiliation: Orthopedic Department, Ha’Emek Medical Center, Afula, 18101 Israel. guytalr@bezeqint.net
authors.forename: Guy
authors.initials: G
authors.lastname: Rubin
authors.forename: Alejandro
authors.initials: A
authors.lastname: Wolovelsky
authors.forename: Micha
authors.initials: M
authors.lastname: Rinott
authors.forename: Nimrod
authors.initials: N
authors.lastname: Rozen
mesh_terms: D006105:Granulomatous Disease, Chronic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*