What are the signs and symptoms of wrist flexor tenosynovitis in rheumatoid arthritis (RA) and how is it treated? Is tenosynovitis sensitive for rheumatoid arthritis (RA)?

Updated: Jun 11, 2021
  • Author: Michael Neumeister, MD, FRCSC, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Answer

Swelling is less obvious in wrist flexor tenosynovitis because of the thicker skin on the volar aspect of the hand. Decreased passive and active motion of the fingers is caused by impairment of the free-gliding movement of the flexor tendons through the sheaths as the thickened synovium proliferates. Proliferative synovitis in flexor tendon sheaths can cause compression of the median nerve and can produce the symptoms of carpal tunnel syndrome. Tendons can also adhere to each other and may rupture. To avoid the consequences of prolonged median nerve compression, early carpal tunnel release and tenosynovectomy is recommended in patients in whom conservative means have failed.

A study by Matthijssen et al indicated that magnetic resonance imaging (MRI)–detectable tenosynovitis is highly sensitive (85%) for RA, with the sensitivity for anti-citrullinated protein antibody (ACPA)–positive RA being 88%, and for ACPA-negative RA, 82%. MRI-detectable tenosynovitis showed a significantly greater sensitivity for RA than for psoriatic arthritis, spondyloarthritis, reactive arthritis, and self-limiting undifferentiated arthritis. [8]


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