Posttraumatic stenosing tendovaginitis of the fourth extensor tendon compartment: a case report

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Musculoskeletal Disorders

Background:

• Stenosing tendovaginitis typically affects the first extensor tendon compartment.
• Pathologies in other extensor tendon compartments are uncommon and may be misdiagnosed.
• This case focuses on a rare presentation in the fourth extensor tendon compartment.

Purpose of the Study:

• To report a case of posttraumatic stenosing tendovaginitis in the fourth extensor tendon compartment.
• To highlight the diagnostic challenges and management of this rare condition.
• To emphasize the importance of intraoperative assessment for accurate diagnosis.

Main Methods:

• Presentation of a case report involving a patient with posttraumatic wrist pain and limited extension.
• Initial diagnosis suggested partial extensor tendon injury via MRI.
• Intraoperative findings revealed stenosing tendovaginitis of the fourth extensor tendon compartment.
• Surgical treatment included synovectomy and Z-plasty of the extensor retinaculum.

Main Results:

• The patient experienced progressive, painful swelling and functional limitation of wrist and finger extension.
• Intraoperative findings confirmed stenosing tendovaginitis, differing from initial imaging.
• Postoperative recovery was successful, with pain resolution and improved range of motion (45° wrist extension with fingers flexed, 10° with fingers extended).

Conclusions:

• This case underscores the rarity of fourth extensor compartment tendovaginitis.
• Thorough intraoperative diagnostics, including mobility assessment, are vital for correct diagnosis.
• Accurate diagnosis guides appropriate surgical intervention for optimal patient outcomes.