x
x

DORSAL TENOSYNOVITIS

Introduction

In patients with dorsal tenosynovitis, the tenosynovium becomes hypertrophic (thickened and swollen). Dorsal tenosynovitis can cause pain as the extensor tendons move on the dorsum of the hand and wrist and collide with the dorsal wrist extensor retinaculum during combined wrist and finger extension. Persistent proliferative dorsal tenosynovitis can cause extensor tendon rupture.1 If the tenosynovitis affects only the first dorsal compartment, which includes the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), it is called DeQuervain’s disease. Symptoms of DeQuervain’s include swelling at the radial styloid. However, DeQuervain’s often occurs with hypertrophic tenosynovial changes.2  
 

Pathopysiology

Initially, the underlying diagnosis causing the dorsal tenosynovitis is frequently unknown and can be difficult to establish. Rheumatoid arthritis (RA), tuberculosis, gout, mycobacterium marinum infections, sarcoidosis or wrist osteoarthritis are diseases that can cause dorsal tenosynovitis. Patients presenting with RA often have involvement of the radiocarpal and distal radioulnar joints and the overlying extensor tendons.1

ICD-10 Codes

  • DORSAL TENOSYNOVITIS

    Diagnostic Guide Name

    DORSAL TENOSYNOVITIS

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    DORSAL HAND TENOSYNOVITIS M65.842M65.841 

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
Dorsal Tenosynovitis
  • Dorsal Tenosynovitis Right Wrist at Arrow extends proximally to extensor retinaculum
    Dorsal Tenosynovitis Right Wrist at Arrow extends proximally to extensor retinaculum
  • Dorsal Tenosynovitis Left Wrist
    Dorsal Tenosynovitis Left Wrist
Symptoms
Swelling and pain on dorsum of wrist and proximal hand
Lump(s) under the skin and superficial to extensor tendons
Lump(s) move with finger motion
Lump(s) interfere with wrist dorsiflexion
Typical History

A few months of dorsal hand and wrist swelling associated with intermittent pain, especially during extension of the fingers and wrist.

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
Dorsal Tenosynovitis
  • Dorsal tenosynovitis - note dorsal soft tissue swelling
    Dorsal tenosynovitis - note dorsal soft tissue swelling
  • Dorsal tenosynovitis - note rare dorsal calcified dorsal tenosynovitis
    Dorsal tenosynovitis - note rare dorsal calcified dorsal tenosynovitis
Treatment Options
Conservative
  • Medical management of the underlying diagnosis causing the dorsal tenosynovitis. In rheumatoid arthritis a few months of proper medical treatment should be tried before surgical treatment such as dorsal tenosynovectomy.
Operative
  • Dorsal tenosynovectomy with preservation or reconstruction of the dorsal extensor retinaculum
  • If treatment is delayed too long, tendon ruptures may occur, which require tendon grafting and/or tendon transfer to maintain function
Complications
  • Limited finger and/or wrist extension
  • Extensor tendon rupture
Outcomes
  • Early and appropriate medical treatment can resolve dorsal tenosynovitis and prevent tendon damage
  • When necessary, surgical treatment and tendon preservation prevent ruptures and maintain useful function
YouTube Video
Dorsal Tenosynovitis
Key Educational Points
  • Dorsal tenosynovitis is a descriptive diagnosis. It is appropriately applied when the tenosynovium on the extensor tendons is hypertrophic (enlarged).
  • Dorsal tenosynovitis is always caused by an underlying disease.
  • Dorsal tenosynovitis can damage extensor tendons and cause tendon ruptures.
  • Dorsal plates and screws for internal fixation of fractures or arthrodesis can irritate the extensor tenosynovium and cause dorsal tenosynovitis.
References
  1. Richards RA, Wilson RL. Management of Extensor Tendons and the Distal Radioulnar Joint in Rheumatoid Arthritis. J Hand Surg Am 2003;3(3):132-44.
  2. Sauvé P, Rhee P, Shin A, Lindau T. Examination of the Wrist: Radial-Sided Wrist Pain. J Hand Surg Am 2014;39(10):2089-92. PMID: 25200760
  3. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
Subscribe to DORSAL TENOSYNOVITIS
⇡