Showing papers by "Lenox Hill Hospital published in 2009"

Seasonal Influenza in Adults and Children—Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management: Clinical Practice Guidelines of the Infectious Diseases Society of America

Abstract: Guidelines for the treatment of persons with influenza virus infection were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic issues, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal (interpandemic) influenza. They are intended for use by physicians in all medical specialties with direct patient care, because influenza virus infection is common in communities during influenza season and may be encountered by practitioners caring for a wide variety of patients.

Influenza estacional en adultos y niños—Diagnóstico, tratamiento, quimioprofilaxis y control de brotes institucionales: Guías de práctica clínica de la Sociedad de Enfermedades Infecciosas de Estados Unidos de América

Abstract: 14 Universidad de Toronto, Ontario, Canada. Es importante advertir que, en las guo´as, no es posible tener en cuenta siempre las variaciones individuales que se presenten entre pacientes. Las guo´as no intentan reemplazar el criterio del medico respecto de pacientes en particular o cuadros clo´nicos especiales. La Sociedad de Enfermedades Infecciosas de Estados Unidos de America considera que la adhesion a estas guo´as es voluntaria y que la determinacion final sobre su aplicacion corresponde al medico conforme a la situacion individual de cada paciente. Los hallazgos y las conclusiones de este informe pertenecen a los autores y no representan, necesariamente, la postura oficial de los Centros para el Control y Prevencion de Enfermedades.

The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty.

Abstract: Background: Early reports on modern ceramic-on-ceramic total hip replacements have demonstrated excellent clinical and radiographic results with few cases of catastrophic failure, which, in the case of earlier designs, often had been caused by implant fracture. Several reports, however, have noted the presence of audible squeaking. The purpose of the present study was to determine the incidence of squeaking in association with the use of this bearing couple. Methods: During the period from March 2003 to May 2005, three surgeons performed 159 total hip arthroplasties in 143 patients with use of a ceramic-on-ceramic bearing. One hundred and forty-nine hips (131 patients) were available for review after at least one year of follow-up. These patients were followed prospectively with use of the modified Hospital for Special Surgery hip score and a patient-administered questionnaire. Additionally, a control group of sixty hips (forty-eight patients) with a metal-on-polyethylene bearing was matched to the ceramic group on the basis of age, sex, and body mass index to compare the incidence of squeaking and other noises. Radiographic evaluations were performed according to previously established criteria. Results: Fourteen (10.7%) of 131 patients described an audible squeak during normal activities. However, squeaking was reproducible clinically in only four patients, and only one patient complained of squeaking before being presented with the questionnaire. The average Hospital for Special Surgery score improved from 19.8 preoperatively to 38.4 at the time of the latest follow-up, indicating excellent clinical results. Ninety-five percent of the patients had a satisfaction score of ≥8 of 10. Three hips dislocated. One of those three hips squeaked and was revised because of recurrent dislocations. One patient was considering revision because of squeaking. In the matched metal-on-polyethylene cohort, there were no cases of squeaking. Conclusions: The squeaking hip is a phenomenon that is unique to total hip replacements with hard-on-hard bearings. The incidence of squeaking in association with ceramic-on-ceramic bearings may be higher than previously reported as <1% of the patients in the present study reported this finding before being queried. The causes and implications of squeaking are yet to be determined. The use of hard-on-hard bearings offers many advantages in terms of wear reduction, especially for young and active patients. Nonetheless, patients considering ceramic-on-ceramic bearings should be counseled with regard to this phenomenon. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Meniscal Root Tears: Diagnosis and Treatment

Abstract: Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. In comparison, however, meniscal root tears (MRTs) often go unnoticed and represent a unique injury pattern with unique biomechanical consequences. Though first described decades ago, improvements in magnetic resonance imaging and arthroscopy have only recently enhanced our diagnostic and treatment capabilities with regard to MRTs. This review contains an anatomic description of the roots including their significance in meniscal function as well as the consequences of their loss. In addition, how to properly identify MRTs and when it is appropriate to surgically repair them are described. Finally, we review the surgical techniques available in the existing literature and present an illustrative case.

Hyponatremia associated with large-bone fracture in elderly patients

Abstract: Hyponatremia has been shown to be associated with gait disturbances, decreased mentation, and falls. The study objective was to determine the incidence of hyponatremia in patients who experienced a substantial skeletal fracture (hip/pelvis/femur). During an 18-month period from March 2007 to August 2008 serum sodium levels were evaluated in 364 cases of bone fracture in patients aged 65 years or older and in 364 nonfracture patients aged 65 years and older seen in an urban emergency room setting. The incidence of hyponatremia in patients with fractures was more than double that of nonfracture patients (9.1% and 4.1%, respectively; P = 0.007). The degree of hyponatremia was noted to be mild to moderate. Mean serum sodium of the entire fracture group was 131 ± 2 mEq/L. In the fracture group the patients were 75.3% female, while females comprised 66.2% of the nonfracture group (P = 0.02). Of fracture patients with hyponatremia, 24.2% were taking antidepressants [3/4 of which were selective serotonin receptor inhibitors (SSRIs)], while none were taking these medications in the nonfracture group. Attention regarding careful follow-up of serum sodium levels in elderly patients seems appropriate.

Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy.

Abstract: Background The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database. Methods A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m 2 ) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, β-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point. Results A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center–initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/1.73 m 2 , after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m 2 and a GFR lower than 30 mL/min/1.73 m 2 was 3.61 (95% confidence interval [CI], 1.42-9.18 [ P = .007]) and 6.81 (95% CI, 2.67-17.35 [ P 2 . Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [ P P = .001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia. Conclusions In nondiabetic patients with hypertensive CKD treated with ACEIs, the risk of hyperkalemia is small, particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m 2 . Including a diuretic in the regimen may markedly reduce risk of hyperkalemia.

Prevalence and prediction of previously unrecognized peripheral arterial disease in patients with coronary artery disease: The peripheral arterial disease in Interventional Patients Study

Abstract: Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown. Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiography and/or intervention and to determine the relationship between presence of PAD and severity of CAD. Methods: The Peripheral Arterial Disease in Interventional Patients Study (PIPS) is a prospective cohort study conducted at an inpatient service of a tertiary referral center. A total of 800 patients referred for coronary angiography without prior diagnosis of PAD aged 70 years or older or aged 50–69 years with a history of tobacco use and/or diabetes mellitus were included. Evaluation involved a medical history, a questionnaire to assess symptoms and functional status, and measurement of the ankle-brachial index (ABI). PAD was considered present if the ABI was 0.90 or less. Results: The prevalence of previously unrecognized PAD was 15%, 95% CI (12.6–17.7) and was highest among patients over 70 years of age (25.2%) and in women (23.3%). Among patients with CAD, those with PAD had higher prevalence of left main and multivessel coronary artery disease (87.2% vs. 75.5%, P = 0.006). Alternatively, patients with multivessel CAD had a twofold higher risk of being diagnosed with previously unrecognized PAD compared with those with single vessel CAD [adjusted OR = 2.02, (95% CI 1.03–3.98)]. Conclusions: PAD is often overlooked even in patients with known ischemic heart disease under specialist cardiovascular care. Overlooked PAD in this population increases in frequency with advanced age, in women, and in the presence of other traditional cardiovascular risk factors. Furthermore, the presence of PAD in this population identifies a subgroup with more severe form of CAD. © 2008 Wiley-Liss, Inc.

Two-year to five-year follow-up of femoral defects in femoral revision treated with the link MP modular stem.

Abstract: Femoral deficiency has been shown to adversely affect the results of revision total hip arthroplasty. Tapered titanium modular stems allow distal fixation of the fluted, conical portion of the implant in the setting of proximal bone loss. One hundred two consecutive hips with proximal bone loss underwent revision femoral reconstruction between 1998 and 2002 at 3 centers using the Link MP modular stem. Forty-three hips had Mallory type 3C femoral deficiency. Ninety-seven hips were observed for an average of 45 months (range, 24-72; median, 36 months). Clinically, mean Harris hip score improved from 36 to 84 (range, 54-99). Radiographically, 93 hips were considered stable, with no circumferential lucencies at the distal fixation surface. Three hips migrated and required revision, along with one periprosthetic fracture. Five other hips had nonprogressive migration of 1 to 2 mm.

Rivaroxaban: a novel, oral, direct factor Xa inhibitor.

Abstract: Thromboembolic disorders such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and stroke often result in long-term disability and/or mortality. The anticoagulants currently available have been effective in the treatment and prevention of these disorders; however, parenteral administration, variable pharmacokinetics and pharmacodynamics, drug and dietary interactions, and a requirement for frequent monitoring of efficacy and safety limit use of these drugs. Rivaroxaban is a novel, oral factor Xa inhibitor in clinical development for the treatment and prevention of thromboembolic diseases. Rivaroxaban is a small molecule directed at active sites, and the agent mechanistically differs from traditional anticoagulants, such as heparins and fondaparinux, in that its activity is independent of antithrombin and its ability to inhibit prothrombinase bound factor Xa. In addition, preclinical and clinical trial data indicate that rivaroxaban has predictable pharmacokinetics and pharmacodynamics, which are features that differentiate it from oral vitamin K antagonists. Phase II studies showed that rivaroxaban is safe and well tolerated across a wide range of doses. Furthermore, completed phase III studies demonstrated its efficacy in the prevention of venous thromboembolism after orthopedic surgery. Additional studies are now under way to evaluate the use of rivaroxaban in the treatment and prevention of other venous and arterial thromboembolic conditions.

Oral anticoagulation with factor Xa and thrombin inhibitors: on the threshold of change.

Abstract: Purpose of review Since the discovery of vitamin K antagonists in the early 1940s, there has been little change in anticoagulation until, in the 1990s, widespread use of low-molecular-weight heparin. Within the next few years, the treatment of arterial and venous thromboembolism is again poised to undergo a major change with the introduction of new oral anticoagulants that are likely to fulfill many of the unmet needs of current warfarin therapy. New drug development has focused on inhibiting specific coagulation factors, with those targeting thrombin and factor Xa being most advanced in development. Recent findings Several landmark studies are now available on the direct thrombin inhibitor, dabigatran etexilate, and the two factor Xa inhibitors, rivaroxaban and apixaban. Recently, dabigatran etexilate received European approval for venous thromboembolism prevention following orthopedic surgery. Rivaroxaban is currently also approved in Europe and Canada for venous thromboembolism prevention in orthopedic surgery, with US Food and Drug Administration approval expected in 2009. Summary New oral anticoagulant approval may provide safer and easier venous thromboembolism prevention and treatment than warfarin. As we stand on this threshold, this article reflects on anticoagulation breakthroughs, summarizes recent studies, and discusses potential drawbacks.

Two types of urgency

Abstract: Aims To determine whether urinary urgency, as defined by the International Continence Society, is an intensification of the normal sensation that occurs when micturition must be delayed once the urge to void is felt (Type 1 urgency) or a discrete, pathologic symptom different from the normal urge (Type 2 urgency). Methods Forty-eight consecutive patients who complained of urinary urgency completed two different questionnaires designed to answer the question posed above. The patients were divided into two groups of 24. For the test–retest, group 1 completed questionnaire 1 twice within 3–10 days and group 2 did the same with questionnaire 2. On the second administration of the questionnaire, each subject crossed over and answered the other questionnaire. For the test–retest, since the data set is dichotomous (yes/no), the degree of agreement between the two sets of data was assessed by calculating the kappa coefficient. Results There were 37 women and 11 men ranging in age from 54 to 87 years. There was no difference in age and sex between the two groups (P = 0.19). There was excellent agreement in the test–retest responses for both questionnaires (kappa = 1.0, P < 0.001). For questionnaire 1, the urge sensation was an intensification of the normal sensation in 33 (68.8%) and it was a different sensation in 15 (31.3%). Similarly, for questionnaire 2, it was an intensification of the normal urge in 34 (70.8%) and different in 14 (29.2%). The differences in patient responses between the two groups were not significant. In the crossover section, only 1 of 48 subjects changed their response, resulting in a very high degree of agreement (kappa = .95, p < .001). Combining the two groups, urgency was perceived as an intensification of the normal urge to void in 33/48 patients (69%), a different sensation in 14/48 (29%) and 1/48 (2%) was not sure. Conclusions Urgency is comprised of at least two different sensations. One is an intensification of the normal urge to void and the other is a different sensation. The implications of this distinction are important insofar as they may have different etiologies and respond differently to treatment. Neurourol. Urodynam. 28:188–190, 2009. © 2009 Wiley-Liss, Inc.

Pulmonary embolism and portal vein thrombosis in an immunocompetent adolescent with acute cytomegalovirus hepatitis

Abstract: Cytomegalovirus infection is usually asymptomatic or resembles infectious mononucleosis with fever, pharyngitis, arthralgias, lymphadenopathy, and atypical lymphocytosis. Even though primary CMV infection is usually self-limited in healthy individuals, significant complications can develop in immunocompromised patients. Venous or arterial thromboembolic phenomena are uncommon, yet very serious complications of CMV infection. Most published reports describe immunosupressed patients after organ transplantation or in the presence of HIV co-infection. However, thrombotic events in CMV infected immunocompetent individuals may occur. We describe the case of an immunocompetent adolescent with acute cytomegalovirus hepatitis that was complicated with pulmonary embolism and portal vein thrombosis. To our knowledge, this is the first reported case in which these two thrombotic phenomena occurred simultaneously in an adolescent with no obvious predisposing factors for thrombosis in the setting of an acute CMV infection.

Magnetic resonance imaging in the diagnosis and management of hip pain after total hip arthroplasty.

Abstract: Evaluation of pain following total hip arthroplasty (THA) can be challenging in the absence of radiographic pathology. This study aimed to examine the diagnostic utility of magnetic resonance imaging (MRI) in the evaluation of enigmatic hip pain following THA. We reviewed a series of patients who were evaluated with MRI after presenting with enigmatic hip pain following THA. MRI was able to demonstrate pathology in the periprosthetic tissues in all hips with minimal artifact. Patients underwent a range of conservative and operative interventions depending on the underlying pathology. If used discriminately in situations where pathology cannot be detected by conventional methods, MRI is a highly effective modality that can aid in the diagnosis of a wide range of disorders thereby allowing the clinician to determine the most appropriate intervention.

Clopidogrel‐Induced Hepatocellular Injury and Cholestatic Jaundice in an Elderly Patient: Case Report and Review of the Literature

Abstract: In patients undergoing percutaneous coronary intervention and in those with acute coronary syndromes, clopidogrel plus aspirin is the first-line antiplatelet therapy for reducing cardiovascular events. Although clopidogrel is generally well tolerated, with rash, indigestion, vomiting, diarrhea, and bleeding being the most common adverse effects, rare but serious complications may occur. We describe a 78-year-old woman who underwent percutaneous coronary intervention with drug-eluting stents; clopidogrel and aspirin were started as antiplatelet therapy. Three weeks later, the patient developed mixed hepatocellular and cholestatic liver injury. Clopidogrel was discontinued, and her liver profile results began to improve. Her diagnostic work-up included screening for hepatitis, infectious mononucleosis, and rheumatologic diseases, as well as ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreaticography; all results were normal. On day 5 of hospitalization, because of the patient's risk for thrombosis secondary to the drug-eluting stents, clopidogrel was reintroduced; her liver enzyme levels increased. In the absence of any biliary obstruction or other obvious causes of hepatic injury, drug-induced hepatocellular injury and cholestatic jaundice were suspected, and clopidogrel was again discontinued. The patient's liver function tests gradually improved 3 days later and showed marked improvement at her 2-week follow-up visit after discharge. Use of the Maria and Victorino scale for diagnosis of drug-induced hepatotoxicity indicated a probable (score of 14) relationship between clopidogrel and mixed hepatocellular injury and cholestatic jaundice in this patient. Although routine liver function testing is not recommended in patients who receive clopidogrel, having a high index of clinical suspicion, drug rechallenge, and excluding other obvious causes are required to establish the diagnosis of a rare drug complication such as clopidogrel-induced hepatic injury.

Antenatal treatment of fetal goiter: a therapeutic challenge.

Abstract: Objective. Pre-natal ultrasonography presents an opportunity for in-utero therapy of a fetal goiter. Because of the morbidity associated with a large goiter and the risks of repeated intra-amniotic...

Stent Parameters Predict Major Adverse Clinical Events and the Response to Platelet Glycoprotein IIb/IIIa Blockade Findings of the ESPRIT Trial

Abstract: Background —Only limited data describe relationships between stent parameters (length and diameter), adverse events following percutaneous coronary intervention (PCI), and effects of platelet glycoprotein IIb/IIIa blockade by stent parameters. Methods and Results —In this post-hoc analysis of the 1,983 patients receiving a stent in the ESPRIT randomized PCI trial of eptifibatide versus placebo, rates of the major adverse cardiac event (MACE) endpoint (death, myocardial infarction, urgent target vessel revascularization or thrombotic bail-out) at 48 hours and 1 year were correlated with stent parameters and then analyzed by randomization to eptifibatide versus placebo. In the placebo group, MACE increased with number of stents implanted, total stent length (by quartiles of 2.5 to <3.5 mm (OR, 0.56 [95% CI, 0.39-0.82; P =0.002]), and with 2 stents implanted (OR, 0.39 [95% CI, 0.22-0.69; P =0.001]. Near-linear relationships were observed between both increasing stent length and increasing stented vessel area and MACE at 48 hours and 1 year (all, P <0.001); these gradients were flattened in the eptifibatide group ( P =0.005 for stent length). Conclusions —Stent parameters predict MACE following PCI. Glycoprotein IIb/IIIa blockade mitigates much of the hazard of increasing procedural complexity.

Monochorionic dizygotic twins in a spontaneous pregnancy: a rare case report

Abstract: Traditionally, monochorionicity in multiple pregnancies is associated with monozygocity. We present a case of a spontaneous, monochorionic dizygotic, sex-discordant twin pregnancy. The diagnosis of monochorionicity was initially done during first-trimester ultrasound evaluation and then confirmed by postnatal placental pathology. Furthermore, both twins were found to have blood chimerism. We also review the literature on dizygotic-monochorionic twins and blood-chimerism. We suggest that further prospective postnatal genetic studies are needed to define the reliability of prenatal diagnosis of identical twins in cases of monochorionicity.

The effect of scapular-retractor fatigue on external and internal rotation in patients with internal impingement.

Abstract: Context: Scapular strengthening is thought to be an important component of the rehabilitation of patients with internal impingement. Objective: To determine the effect of scapular-retractor-muscle fatigue on internal- and external-rotation-torque production in patients with internal impingement. Design: Case control study. Setting: Outpatient clinic. Participants: 15 patients and 18 healthy subjects. Intervention: A scapular-retractor-fatigue protocol. Main Outcome Measure: Shoulder-rotation- torque production. Results: After the scapular-retractor-fatigue protocol external- rotation strength was reduced in patients (involved 25%, noninvolved 19%; P < .001). Conclusion: Fatigue in the scapular retractors resulted in lower shoulder-rotation-torque production. These findings emphasize the importance of the scapular retractors for proper function of the shoulder rotators with the arm in an abducted position in patients with internal impingement.

A case of bovine ketoacidosis in a lactating woman

Abstract: A 36 year-old 5 weeks postpartum lactating woman presented to the emergency room with severe nausea and vomiting for 48 hours. The patient was found to be in non-diabetic ketoacidosis with a serum pH 6.9 and a HCO3 of <5mEq/L. This condition rapidly improved with the administration of intravenous dextrose and bicarbonate and with the cessation of breast feeding. The course and pathophysiology of the rarely described phenomenon of bovine ketosis in a human is discussed here.

Antibiotic resistance: the ongoing challenge for effective drug therapy.

Abstract: The abilities to evolve and exchange DNA are unique survival tactics used by bacteria. Overcoming these mechanisms is a clinical challenge for the 21st century. Antibiotic resistance is an increasingly common problem that complicates the treatment of both community‐acquired and nosocomial infections. A series of three articles reviews this serious health threat, explains why the challenge is never‐ending, and offers possible solutions. In this article, the author discusses the factors that contribute to antimicrobial resistance and the mechanisms that bacteria use to achieve resistance. The second and third installments of this series will appear in the April and May issues, respectively.

Carbonic anhydrase IX and human papillomavirus as diagnostic biomarkers of cervical dysplasia/neoplasia in women with a cytologic diagnosis of atypical glandular cells: a Gynecologic Oncology Group study in United States.

Abstract: High-risk human papillomavirus (H-HPV) infection is strongly linked to cervical neoplasia, but its role in detecting glandular lesions (GLs) is unclear. In the cervix, carbonic anhydrase IX (CA-IX) is expressed in cervical neoplasia, but rarely in the benign cervix. The diagnostic utility of these biomarkers was evaluated in women with a cytologic diagnosis of atypical glandular cells (AGC). H-HPV was detected using hybrid capture 2 (HC2) in liquid-based cytology, and CA-IX immunoreactivity was studied on conventional Pap smears. Of 403 patients, 111 (28%) were positive for significant cervical lesions (SCLs) including CIN2, CIN3, adenocarcinoma in situ or invasive carcinoma. CA-IX testing alone (n = 403) had a sensitivity of 75, 95 or 65% for SCLs, significant GLs or squamous lesions (SLs), respectively, with a specificity of 88% and a false negative rate (FNR defined as 1 minus negative predictive value) of 10%. Testing for H-HPV (n = 122) had a sensitivity of 97, 100 or 96% for SCLs, GLs or SLs, respectively, with a specificity of 87% and a FNR of 1%. The combination of CA-IX and H-HPV testing (n = 122), collectively, had the same sensitivity, specificity and FNR for SCLs, GLs or SLs as H-HPV testing alone. The conclusions of our study are that both H-HPV and CA-IX testing are useful diagnostic markers for GLs. However, H-HPV testing is a better diagnostic marker for SLs. The combination of CA-IX with H-HPV testing does not improve the diagnostic accuracy for cervical neoplasia in women with AGC diagnosis over that of H-HPV testing alone.

Proliferative extensor tenosynovitis of the wrist in the absence of rheumatoid arthritis.

Abstract: Purpose Proliferative tenosynovitis in the fourth extensor compartment is common in patients with rheumatoid arthritis. It may also occur in the absence of rheumatoid arthritis; the purpose of this study is to describe this clinical condition in a series of patients, to report the results of surgical intervention, and to compare histological findings to those typically seen in rheumatoid tenosynovitis. Methods This study presents a retrospective case series of 11 patients who do not have rheumatoid arthritis, who had proliferative tenosynovitis of the fourth extensor compartment treated surgically. Relevant features of the clinical presentation, physical examination, radiographic findings, and results of attempts at conservative treatment are described. Surgical pathology specimens were reviewed by a single pathologist to define common histological features and to compare the histology to that which is classically seen in rheumatoid tenosynovitis. Results All patients presented with a painful wrist mass over the fourth extensor compartment. Characteristic in physical examination was severe limitation of active wrist extension with the fingers extended, with improvement when the fingers were flexed into a fist. After tenosynovectomy, wrist extension and grip strength improved. Examination of the surgical pathology specimens revealed a spectrum of pathological findings generally consistent with traumatic tenosynovitis, but a few specimens had rheumatoid-like features. Conclusions A review of this case series of patients with tenosynovitis but without rheumatoid arthritis demonstrates a distinct clinical condition of exuberant proliferative extensor tenosynovitis blocking proximal tendon excursion, thereby causing pain and limited active wrist extension, as well as a less distinct histological condition with a constellation of findings generally resembling traumatic tenosynovitis. In this group of patients, surgical tenosynovectomy generally yields excellent results. Type of study/level of evidence Therapeutic IV.