Applying ice to the affected area. Patients present with locking of the finger in flexion and clicking or snapping. Hand and finger tendon injuries It commonly manifests as pain, swelling, and contractures, depending on the etiology. The risk of developing trigger finger increases up to 10% in diabetics.There also appears to be a higher … Draeger RW, Bynum DK Jr. Flexor tendon sheath infections of the hand. They usually start as tendon irritation manifesting as pain, and can progress to catching and locking when tendon gliding fails. The tendon can be involved by primary inflammatory disorders, such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily involves the joints. ANATOMY Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness.Tenosynovitis can be either infectious or noninfectious. Initial treatment of de Quervain's tenosynovitis may include: Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons. Canoso, J. J. Tenosynovitis of the hand and wrist are a group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. Most acute cases of flexor tenosynovitis (FT) are infectious but may also be secondary to inflammation from noninfectious cause (e.g. Kanavel signs for flexor tenosynovitis (REVISITED) pain on passive extension (early finding) finger held in flexion. Pyogenic flexor tenosynovitis is an infection of the synovial sheath that surrounds the flexor tendon. Pyogenic tenosynovitis occurs almost exclusively in the flexor tendons of distal extremities, more commonly in the hand/wrist than the ankle/foot. Kanavel's cardinal signs is used to diagnose infectious tenosynovitis. It is generally just called trigger finger, but the medical name for it is stenosing flexor tenosynovitis. Can J Plast Surg 2003;11(3):143-144. (2020). Majority of the cases of flexor tenosynovitis are infectious in nature; however, flexor tenosynovitis can also occur due to inflammation from noninfectious causes, … Treatment involves rest, NSAIDs and immobilization for 3-6 weeks. A successful outcome was defined as ab- sence of triggering and pain, both sub- jectively and on examination. Posted on July 31, 2014 by sinaiem. For patients with suspected flexor tenosynovitis, the mainstay of diagnosis is a thorough history and physical examination. Contact the professionals at Florida Orthopaedic Institute today for more information or to schedule an appointment if your'e suffering with these symptoms. Diagnosis is made by PA wrist radiographs which reveal positive ulnar variance with subchondral sclerosis of the ulnar styloid and/or triquetrum. Splint hand with: Wrist in 30 deg of flexion. When this happens, the flexor tendon catches and the patient is unable to extend or flex the finger. Flexor Tenosynovitis. The area around the tendon then would seem more stiff and swollen. The patient is presenting with Kanavel’s cardinal signs of flexor tenosynovitis. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Most acute cases of flexor tenosynovitis (FT) are infectious but may also be secondary to inflammation from noninfectious cause (e.g. Digital flexor sheaths are a closed continuous synovial system that invest the flexor digitorum … Misdiagnosis or failure to diagnose this disease may results in adhesions, tendon vascular compromise, and necrosis with loss of finger function and potential loss of hand function as the infection spreads. They are: tenderness to touch along the flexor aspect of the finger, fusiform enlargement of the affected finger, the finger being held in slight flexion at rest, and severe pain with passive extension. Flexor tendons run from the forearm to the ends of the fingers across the palm side of the hand. flexor tenosynovitis - UpToDate Infectious tenosynovitis …percent) but low specificity (51 to 69 percent) for flexor tenosynovitis . Tenosynovitis refers to inflammation of a tendon and its synovial sheath; this condition occurs most frequently in the hand and wrist but can occur in any part of the extremities where a tendon glides within a synovial-lined fibro-osseous sheath. They usually start as tendon irritation manifesting as pain, and can progress to catching and locking when tendon gliding fails. Shima’a Jaffer Al-Amer 211504748 TRIGGER FINGER. 2. Gymnast's wrist is a distal radius physeal injury most commonly due to overuse of the wrist primarily affecting young gymnasts. Flexor Tenosynovitis (Kanavel’s Signs) Posted on October 4, 2012 by Ali. Diagnosis is made clinically with the presence of the 4 Kanavel signs. تتراوح شدة علامات وأعراض الإصبع الزنادية بين الخفة والحدة وتتضمن ما يلي: تيبس الإصبع خاصةً في الصباح. Similar to trigger finger (or stenosing flexor tenosynovitis), this disease involves a noninflammatory thickening of both the tendons and the tunnel (or sheath) through which they pass. Abstract For patients with suspected flexor tenosynovitis, the mainstay of diagnosis is a thorough history and physical examination. IP joint flexed 10-15 deg of flexion. 1. Treatment is a course of rest, NSAIDs and splinting. Flexor Tenosynovitis.OrthopClin N Am 2017;48:217-27. Normal Anatomy Flexor digitorum profundus Flexor digitorum superficialis. Tenosynovitis (non-infectious) — Pain, tenderness, and swelling along the flexor tendon in the hand may be associated with an underlying inflammatory arthritis such as rheumatoid arthritis or reactive arthritis. Untreated PFT may rapidly destroy the gliding mechanism, cause adhesion formation, and potentially give rise to necrosis of the tendon and its fibro-osseous sheath. Empiric antibiotics should be started immediately on diagnosis covering skin flora and gram-negative bacteria. Signs and symptoms include joint pain, difficulty moving a joint, a slightly flexed finger at rest, edema, and muscle tenderness. The affected finger is held slightly flexed and it is extremely painful (or impossible) for the patient to completely straighten the finger. Objectives: • Normal anatomy of region • Aetiology • Clinical presentation • Investigations • Treatment • Complications. Tenosynovitis of the hand and wrist is a group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. It is a common diagnosis/finding on MRI scans now. Trigger finger is a common cause of hand pain. Epidemiology Incidence 2.5 to 9.4% of all hand infections Risk factors diabetes Signs and symptoms []. Posted by S. Lee at 8:00 AM. Tenosynovitis is a broad term describing the inflammation of the fluid-filled synovium within the tendon sheath. However, synovitis under the extensor retinaculum can easily be mistaken for a dorsal ganglion as the swelling lies in a similar position (though it is commonly broader and flatter). Kanavel’s sign: clinical sign found in patients with flexor tenosynovitis (infection of flexor tendon sheath of hand) – involved digit kept in flexed position – tenderness to palpation over tendor sheath – pain with passive extension of digit – fusiform swelling of digit Two cases of post-traumatic stenosing flexor tenosynovitis (flexor tendon entrapment or trigger digit) are presented. 3 If misdiagnosed, flexor sheath infections can lead to serious, life-threatening consequences. The presence of the four Kanavel signs is a strong diagnostic aid. Digital flexor tendinitis and tenosynovitis are inflammation, sometimes with subsequent fibrosis, of tendons and tendon sheaths of the digits. Fifty-eight patients with 77 episodes of flexor tenosynovitis of the hand that was resistant to rest, therapy with nonsteroidal anti-inflammatory drugs, and/or splinting were treated with single or multiple injections of depo-methylprednisolone acetate or triamcinolone acetonide. Introduction: Digital pyogenic flexor tenosynovitis requires fast, aggressive treatment. Flexor hallucis longus (FHL) tenosynovitis is commonly referred to as “dancer’s tendinitis” due to its high prevalence among professional female ballet dancers. 2. Clinicians must be able to identify the disorder, know the broad range of treatment options, and counsel patients on the treatment best suited for their condi-tion. Practical points. Natalie was getting surgery on her thumb. Stenosing flexor tenosynovitis, more commonly known as trigger finger, is one of the most common causes of hand pain and dysfunction. J Bone Joint Surg Am 2007; 89:1742. Most commonly documented in the literature of the rarer extensor pyogenic tenosynovitis are case reports in the upper extremities caused by atypical bacteria or fungi, with only two cases caused by … Diagnosis is suggested by Kanavel signs and confirmed with x-rays. In the established case, rheumatoid tenosynovitis is usually obvious with the presence of other stigmata of the condition. 腱鞘炎; 患有先天狹窄性腱鞘炎的大拇指: 症状: 關節疼痛、腫脹、關節活動受限: 类型: 關節病變, 滑膜炎, tendon sheath disorder[*], 肌腱炎[*]: 肇因: 感染、重複性勞損: 診斷方法: 病史、理學檢查、 微生物培養 （ 英语 ： Microbiological culture ）: 治療: 藥物、鞘管 沖洗治療 （ 英语 … Pang HN, Teoh LC, Yam AK, et al. J Am Acad Orthop Surg, 15(12): 757-64. Abstract Stenosing flexor tenosynovitis of the digital flexor tendon sheath, also known as trigger finger, occurs when there is a size mismatch between the flexor tendon and the surrounding retinacular pulley system at the first annular (A1) pulley. diabetes, overuse, arthritis) Infectious tenosynovitis Simply resting your hand for four to six weeks is often enough to fix trigger finger. Physiotherapy is an option. Pyogenic flexor tenosynovitis is a closed-space infection of the flexor tendon sheath. Tenosynovitis refers to inflammation of a tendon and its synovial sheath; this condition occurs most frequently in the hand and wrist but can occur in any part of the extremities where a tendon glides within a synovial-lined fibro-osseous sheath. Stenosing tenosynovitis (trigger finger) is one of the most common hand conditions, with a prevalence of 2% in the general population. Flexor tenosynovitis and de Quervain’s tenosynovitis are the 2 most common types of tenosynovitis of the hand. Most advocate antibiotics. Review this table for a few considerations to the patient with a finger in flexion. tenderness to percussion along flexor tendon sheath (late finding) Reference (s): uptodate.com: infectious tenosynovitis; study; picture. Tenosynovitis = inflammation of a tendon and its sheath. Eosinophilic Esophagitis (EE) --mimics GERD and may result in narrowing or stricture of the esophagus. J Am AcadOrthopSurg 2012;20:373–82. Flexor sheath infections, also known as infected tenosynovitis, are a relatively common infection of the hand with a prevalence ranging from 2.5% to 9.4% of hand infections. Treating trigger finger. It most often affects the fourth digit, but can affect multiple digits at the same time. Given his IV drug use, he is at increased risk for developing this surgical emergency. Patients were injected with either 1 cc of betametha- sone (Celestone 6 mg) and 3 cc of 1% lidocaine, or 4 cc of 1% lidocaine alone. Avoiding repetitive thumb movements as much as possible. uniform swelling of finger. Suppurative (infectious) flexor tenosynovitis is a medical emergency because the tendon sheath is a closed space and too much swelling can lead to compartment syndrome and necrosis. Flexor tenosynovitis is an inflammation of the tendon sheath that can be caused by either introduction of infection or various inflammatory conditions ranging from autoimmune arthropathies to crystal joint depositions. It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. Issues related to infectious tenosynovitis will be reviewed here. Monica Ramirez Curtis, MD, MPH INTRODUCTION Trigger finger (also called stenosing flexor tenosynovitis) is caused by a disparity in the size of the flexor tendons and the surrounding retinacular pulley system at the first annular (A1) pulley ( figure 1) which overlies the metacarpophalangeal (MCP) joint ( figure 2 ). It is most commonly caused by a penetrating injury to the finger. The symptoms of flexor tenosynovitis are of increasing pain, usually in a single finger (or the thumb), with swelling, increased warmth and redness of the whole finger. Stenosing flexor tenosynovitis, more commonly known as trigger finger, is one of the most common causes of hand pain and dysfunction. RA causes damage mediated by cytokines, chemokines, and metalloproteases. If the tendon communicates with a joint, such as the long head of biceps at the shoulder and flexor hallucis longus at the ankle, then no fluid should be present in the joint to make the call. 1 Trigger finger. 9 For flexor tenosynovitis, UpToDate recommends local injection when symptoms persist for 4 … Follow- up examination was completed for all Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum.Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections … The medical liter-ature contains few reports of this uncommon etiology for a problem that afflicts at least 2% of the adult population. Flexor tenosynovitis is a condition where there is inflammation around the flexor tendons of the finger. due to inflammation of flexor tendons from repetitive gripping or pressure on palms which results in catching or locking • PE • Flexor tendon obstruction near MCP head • Tx • Rest including buddy taping, injection Trigger finger 29 They control the ability to bend fingers down to the palm (for example to make a fist, grip, or pinch objects). Factors affecting the prognosis of pyogenic flexor tenosynovitis. Specific causes resulting in this type of inflammation include: Overworking the joint with repetitive motion. HS001 NON-OPERATIVE MANAGEMENT OF ACUTE INFECTIOUS FLEXOR TENOSYNOVITIS: A REVIEW OF THE LITERATURE Sibon Fuzzard, Conor Morris, Vicky Tobin, Warren Rozen and David Hunter-Smith Peninsula Health, VIC. UpToDate recommends steroid injection for de Quervain's tenosynovitis if pain persists for more than 2 to 6 weeks despite splinting, icing, and NSAID therapy. Digital flexor tendinitis and tenosynovitis are idiopathic but are common among patients with rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily involves the joints. DOI: 10.1056/NEJM195002162420702. You need the best evidence and clinical guidance at your fingertips to answer even the most complex questions with confidence. 3. Treatment is urgent irrigation and debridement of the flexor tendon sheath with IV antibiotics. DISCUSSION. In case of Infectious Flexor Tenosynovitis, patient has the Kanavel’s signs which are: 1 There is fusiform swelling of the finger (sausage finger). 2 The finger is held or bent in a slightly flexed position. 3 Patient feels pain with passive extension of the affected digit. 4 There is tenderness present along the flexor tendon sheath. Trigger finger is also known as stenosing tenosynovitis (stuh-NO-sing ten-o-sin-o-VIE-tis). A recent sexually transmitted infection may indicate a type of gonorrhea-related infection, which may resemble infectious flexor tenosynovitis. A basic understanding of the tendon … Swan Neck Deformities are degenerative conditions, often seen with rheumatoid arthritis, characterized by hyperextension of the PIP joint and flexion of the DIP joint due to an imbalance of muscle forces on the PIP. Kennedy, Colin D., Jerry I. Huang, and Douglas P. Hanel. The reported prevalence is 2-3 % of the general population and most often appears in the middle 5th and 6th decades of life (2). It is caused by stenosis at the level of the first annular (A1) pulley, which interrupts the smooth gliding of the underlying flexor tendons at the level of the metacarpophalangeal joint. The examination is guided by evaluating the patient for Kanavel’s four cardinal signs. Trigger finger is the common name for a hand condition your doctor might call stenosing tenosynovitis.It happens when something inflames a band of … Ilyas AM, Ast M, Schaffer AA, et al (2007). Trigger finger/thumb is one of the most common causes of hand pain in adults. While the term “tenosynovitis” implies an inflammatory condition, pathoanatomically it is better described as a friction overuse injury, resulting in fibrosis of the surrounding tissue and subsequent narrowing of the synovium. Rheumatoid extensor tenosynovitis. If you have de Quervain's tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist. --In a cohort, 71% percent of patients with EE were male with a mean age of 10.5+/-5.4 years. Hand surgeon should repair all flexor tendon lacerations. Diagnosis is made clinically with tenderness at the distal radius with radiographs showing widened distal radial growth plate with ill-defined borders. J Hand Surg, 32(4): 472-3. Causes of trigger finger. The condition can affect any tendon in the body surrounded by a sheath but has a predilection for the hand, wrist, and foot. Flexor Tenosynovitis. Infectious flexor tenosynovitis is an acute infection within the flexor tendon sheath. “Fusiform.” Dictionary.com. We often don't know exactly what causes trigger finger. If hand surgeon is not immediately available: Irrigate open wounds and close with 5-0 nylon. Background: Infectious flexor tenosynovitis is a bacterial infection of the flexor tendon sheath which can spread … Tenosynovitis of the hand interosseous tendons was found in 47.7 % of patients with RA. Surgical emergency - flexor sheaths are contiguous with deep spaces of the hand; Usually associated with a penetrating trauma; Clinical Features Kanavel's Signs. diabetes, overuse, arthritis) Infectious tenosyn…. PRESENTATION — Patients with de Quervain tendinopathy describe pain at the radial side of the wrist that is more notable with thumb and wrist movement. Tenosynovitis of the tendon sheath begins with acute inflammation. UpToDate: Evidence-based Clinical Decision Support. Flexor tenosynovitis caused by infection is an orthopedic emergency. Flexor tenosynovitis means that one of the flexor tendons sheaths (i.e. Post-traumatic stenosing flexor tenosynovitis. It occurs up to 6 times more frequently in women (1). We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year-old patient with seronegative rheumatoid arthritis. 89647 . If the tenosynovitis is infective, urgent surgical assessment is required. N Engl J Med 1950; 242:241-244. Serious cases can form cysts that tear or break tendons, change the shape of your hand , and make it hard to use. Avoiding pinching with your thumb when moving your wrist from side to side. This often progresses to painful episodes in which the patient has difficulty spontaneously ... UpToDate. Therapy. Clinicians must be able to identify the disorder, know the broad range of treatment options, and counsel patients on the treatment best suited for their condition. الأعراض. Trigger finger, or stenosing flexor tenosynovitis, is one of the most common causes of hand pain in adults, and its pathogenesis is often idiopathic. If inflammation is present in a tendon, the salt associated with eating meat potentially can cause water retention that could lead to further swelling around the involved tendons that could make the tendonitis appear worse. She reported that her family physician gave her an injection in that finger 6 months ago for her symptoms… References: Aggarwal R, Blazar PE (2017) Dupuytren's contracture. Empiric antibiotics should be started immediately on diagnosis covering skin flora and gram-negative bacteria. Patients were prospectively followed up for an average of 4.6 years. الشعور بطقطقة أو فرقعة عند تحريك الإصبع. Common clinical manifestations of noninfectious tenosynovitis include de Quervain tendinopathy and stenosing tenosynovitis (more commonly known as … Giant Cell Tumor of Tendon Sheath, also known as pigmented villonodular tumor of the tendon sheath, is a benign nodular tumor that is found on the tendon sheath of the hands and feet. 12 July 2016. http://www.dictionary.com/browse/fusiform. Materials and methods: Between 2011 and 2015, 22 patients with acute pyogenic flexor tenosynovitis were treated with a single open debridement followed by irrigation; the incision was closed and a 10-day antibiotic course … --differentiated from GERD by the amount of mucosal eosinophilia and lack of response to acid suppression. In: Post T, ed. 1. February 16, 1950. Synovitis causes usually have a link to incidents of trauma and related health conditions. Flexor tenosynovitis may be due to trauma or it may be systemic in origin. This strain can cause unwanted pain and stress. Recent ultrasonography (US) and magnetic resonance imaging (MRI) studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and that the enlargement of the joint capsule is not an indispensable condition for the 'sausage-like' feature. ANATOMY Infectious tenosynovitis occurs between 2.5% and 9.4% of all hand infections. Treatment consists of parenteral antibiotics and sheath irrigation. De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. MCP joints in 70 deg of flexion. … De quervain tenosynovitis of the wrist. (9) For flexor tenosynovitis, UpToDate recommends local injection when symptoms persist for 4 to 6 weeks despite splinting. Flexor tenosynovitis (FTS) is a surgical emergency. If trigger finger is severe, your finger may become locked in … For over a year, Natalie could not straighten her thumb due to a congenital condition known as trigger thumb, also called stenosing flexor tenosynovitis. The patient reported a 5-month history of painful swelling of the right wrist. Flexor Tendon Injuries. summary. When you care for patients, the stakes are high and every decision counts. either the flexor hallucis longus or flexor digitorum longus tendons) of the foot has more fluid in it than normal, usually due to inflammation. TJ Best. Ultrasound showed pronounced swelling of the synovial tissue of the flexor tendons. 88139 : Iwasaki N, Ishikawa J, Minami A (2007). 1 For over a year, we would giggle when she gave us a crooked “thumbs up.”. This lets any inflammation clear up and may solve the … Palpation of the tendon sheath proximal and distal to the abscess helps to differentiate it from pyogenic flexor tenosynovitis Dorsal skin is loosely anchored to underlying tissue, so infection can spread to 2 places: the dorsal subcutaneous space (superficial to the extensor tendons) and the dorsal aponeurotic space (deep to the extensor tendons). Swan Neck Deformity. The examination is guided by evaluating the patient for Kanavel's four cardinal signs. Ulnar Styloid Impaction Syndrome is a common cause of ulnar-sided wrist pain secondary to impaction between the ulnar styloid tip and the triquetrum. This can sometimes lead to the long-term, or chronic, form of tenosynovitis. It is an infection of the tendon and synovial sheath of the flexor surface of the hand. In one study including 75 patients with upper extremity infectious flexor tenosynovitis, the earliest finding was pain with passive extension … Trigger finger (stenosing flexor tenosynovitis) … Issues related to infectious tenosynovitis will be reviewed here. Flexor tenosynovitis or Trigger finger clinical manifestation is painless snapping, catching, or locking of one or more fingers during flexion of the affected digit. The acute infectious etiology of pyogenic flexor tenosynovitis (PFT) is a closed-space infection of the flexor tendon sheath, which represents a surgical emergency. Alerts and Notices Synopsis Trigger finger, also called stenosing flexor tenosynovitis, is a painful disorder of flexor tendons in the hand. Infectious flexor tenosynovitis: A history of a puncture wound or cut will aid the diagnosis. It involves one of your tendons, the strong tissue that attaches a muscle to a bone. mary flexor tenosynovitis. This association and the symptoms separate it from similar joint conditions, even though there is a risk of misdiagnosis. Tenosynovitis = inflammation of a tendon and its sheath. Although this infection occurs frequently, treatment consensus is lacking. Pyogenic flexor tenosynovitis is an infection of the synovial sheath that surrounds the flexor tendon. Diagnosis is made clinically with the presence of the 4 Kanavel signs. Treatment is urgent irrigation and debridement of the flexor tendon sheath with IV antibiotics. What percentage of hand infections are pyogenic flexor tenosynovitis? Suppurative (infectious) flexor tenosynovitis is a medical emergency because the tendon sheath is a closed space and too much swelling can lead to compartment syndrome and necrosis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). Flexor Tendonitis can occur when there is a strain on the tendons. Tenosynovitis is the inflammation of a tendon and its synovial sheath ().This inflammation is often due to tendon overuse (e.g., texting, typing), but can also be due to systemic diseases (e.g., rheumatoid arthritis, sarcoidosis) or infection following a penetrating injury (e.g., animal/human bites, thorn prick injury).The tendons of the hand and wrist are most commonly … [Comment] Trigger wrist caused by tendon adhesion between the flexor pollicis longus and flexor digitorum superficialis tendons. UpToDate recommends steroid injection for de Quervain’s tenosynovitis if pain persists for more than 2 to 6 weeks despite splinting, icing, and NSAID therapy. 4/4(347-349), Infectious etiologies will include erythema and fever. The A1 pulley overlies the metacarpophalangeal (MCP) joint at the base of the finger. When these tendons are cut or injured, it can be impossible to bend the fingers or thumb. 8 This condition is caused by inflammation and narrowing of the A1 pulley, often resulting in a painful locking and triggering when the finger is flexed. Other Resources UpToDate PubMed. Pain with passive extension (often the first sign seen) Percussion tenderness (tenderness over entire length of flexor tendon sheath) 29 Flexor Stenosing Tenosynovitis: Trigger Finger and Thumb Kevin D. Plancher History and Clinical Presentation A 45-year-old right hand dominant woman was seen in the office because her right middle finger was stuck in her palm. De-Quervain's tenosynovitis Title: Tuberculous flexor tenosynovitis of the hand Citation: International Journal of Mycobacteriology, December 2015, vol./is.
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