Utility of Routine Histopathologic and Culture Analysis in Wrist Tenosynovectomy.

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Pathology

Background:

• Routine diagnostic practices in surgery require ongoing evaluation for clinical utility.
• Tenosynovectomy procedures for flexor or extensor tendons are common in hand surgery.
• The value of routine histopathologic and culture analysis in these cases is not well-established.

Purpose of the Study:

• To evaluate the clinical impact of routine histopathologic and culture analysis in patients undergoing flexor or extensor tendon tenosynovectomy.
• To determine if these routine diagnostic tests alter patient management or treatment courses.

Main Methods:

• Retrospective review of 57 patients undergoing tenosynovectomy from 2018-2023.
• Analysis of demographics, medical history, and surgical details.
• Assessment of changes in patient care based on histopathology and culture results.

Main Results:

• Histopathology did not alter care in 20 patients with known inflammatory conditions.
• One of 37 patients without a known inflammatory condition was diagnosed with rheumatoid arthritis based on pathology.
• Cultures were positive in 74% of patients with suspected infection, but only one patient without suspected infection (Mycobacterium marinum) had a positive culture that altered care.

Conclusions:

• Routine histopathologic analysis of tenosynovium is not beneficial in patients with known inflammatory conditions.
• Histopathology and cultures rarely alter care in patients without suspected infection or known inflammatory conditions.
• Discontinuation of routine histopathology for specific patient groups may be warranted, while selective use of cultures should continue.