Advances in Tenoscopy and Bursoscopy

In recent years endoscopic evaluation of tendon sheaths and synovial bursae has made a major contribution to understanding the pathogenesis of tenosynovitis and bursitis. This has included the identification of previously unreported lesions in all locations. Some have subsequently been identified by other diagnostic techniques but endoscopy remains the modality of choice for determination of lesion morphology. As a result, the rational intervention has, for the most part, replaced symptomatic treatment. Endoscopy has also permitted minimally invasive surgical approaches to perithecal structures with consequential benefits of diagnostic accuracy, targeted treatment, improved prognosis and reduced morbidity.

Endoscopic evaluation and treatment of the digital flexor tendon sheath and navicular bursa are dealt with separately. This presentation will give an overview of tenoscopy of aseptic conditions involving carpal and tarsal flexor and extensor tendon sheaths, including tarsal synoviocoeles and of endoscopy of the calcaneal and bicipital bursae.

Variations of the proximolateral arthroscopic approach to the carpal sheath of the digital flexor tendons (Southwood et al 1998; McIlwraith et al 2005) offer the most comprehensive and clinically useful evaluation. This permits treatment of radial osteochondromata (Southwood et al 1997; Wright and Minshall 2012b), radial physeal exostoses (Nixon 2002; Nixon et al 2004), tears of the radial head of the deep digital flexor (Minshall and Wright 2012a). It also provides access for desmotomy of the accessory ligament of the superficial digital flexor (Southwood et al 1999), release of the carpal flexor retinaculum (Textor et al 2003) and desmotomy of the accessory ligament of the deep digital flexor (Caldwell et al 2011). Fractures of the accessory carpal bone and intrathecal tearing of the flexor tendons and accessory ligament of the superficial digital flexor have also been treated using this technique.  [...]