WHAT YOU SHOULD KNOW
Patients may develop large amounts of swelling around certain tendon groups in the hand and wrist region. The swelling often just keeps slowly getting larger. The reasons for such swelling are either a special inflammatory condition such as rheumatoid arthritis or a slow growing infection caused by either a fungus or atypical mycobacteria.
MEDICAL HISTORY
Patients may complain of a dull ache or limitation of motion of function in the affected body part. Usually the patient cannot remember any specific event that matches the problem starting.
EXAMINATION
The swollen tissue feels spongy and matches the anatomy of a certain group of tendons. Sometimes, the mass of spongy tissue can be seen to move back and forth when the tendons move.
ADDITIONAL TESTS
In rare cases a Magnetic Resonance Image picture will be taken before surgery. The tissue obtained at the time of surgery is sent to 2 different laboratories: one to make a microscope slide and determine what type of tissue it is, the other is the infection laboratory where cultures will be grown to identify a fungal or atypical mycobacterial species causing infection.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL EXCISION | |
| CONSISTS OF | Cortisone injection of the swollen tissue | Remove all swollen tissue around tendons |
| FEATURES | Designed to limit inflammation | Complete excision, outpatient surgery |
| ADVANTAGES | Partially and temporarily effective if due to rheumatoid arthritis | Obtains sample for laboratory |
| DISADVANTAGES | No effect if due to infection | Laboratory does not always generate a clear answer, recurrence is possible |
RECOVERY
Sutures are removed in the office at 2 weeks. The area where the tissue was removed usually becomes quite stiff and needs outpatient rehabilitation exercises under the guidance of a therapist. If the infection laboratory identifies a fungus or atypical mycobacterial species, the patient will need to take antibiotics for many months to kill any remaining microscopic disease too small to be seen at the time of surgery. If the laboratory work does not identify any cause, recurrence becomes more likely. If special arthritis conditions are identified, the patient will consult with a rheumatologist.
