Lesional pattern and clinical symptoms in rheumatoid flexor tendon disease

Objectives: To assess complaints and clinical findings of rheumatoid hand flexor tendon disease in relationship to the anatomical site and the type of lesion in order to improve the diagnosis and enable early operative treatment with preservation of hand function. Methods: 123 patients of the hands of 78 patients (66 female, 12 male) with a mean age of 57 years were analyzed retrospectively. Preoperative complaints and clinical findings were recorded according to their frequency. Three different types of flexor tendon disease were distinguished intraoperatively: isolated tenosynovitis, tenosynovitis with tendon lesion, and complete tendon rupture. Results: 188 tendons showed isolated synovitis, 208 had a tendon lesion with synovitis, and 30 tendons a rupture. Tenosynovitis was found in the palm and wrist mainly. The 2nd, 3rd and 4th finger were most frequently involved. 81 tendon adhesions, 12 nodules, 63 superficial lesions and 52 defects were detected. These lesions were found mainly in the palm and the second and third ray. The profundus tendon was affected most often. Ruptures were detected most often in the wrist caused by bony spurs and tenosynovitis. A clinical difference between tenosynovitis with and without tendon lesion was not found. However, complaints and findings were different in the digit, palm, wrist and forearm. Ruptures had characteristic clinical findings. Conclusions: Rheumatoid flexor tendon disease is common. Tenosynovitis is often accompanied by tendon lesions. Ruptures occur as disease progresses. Exact assessment of complaints and clinical findings is mandatory to diagnose and localize flexor tendon disease. Early operative intervention helps to preserve the function of the hand.