Early detection and treatment of complications in the fingers and hand after arthroscopic rotator cuff repair

Abstract

Background: Complications in the fingers and hand after arthroscopic rotator cuff repair (ARCR) have been reported to include carpal tunnel syndrome (CTS), flexor tenosynovitis (TS), and complex regional pain syndrome. These studies were conducted retrospectively; however, the reported complications have not been examined prospectively. The aim of this study was to evaluate the outcomes of early detection and treatment of the complications after ARCR.

Methods: Forty-six patients (48 shoulders) who underwent ARCR were prospectively examined to investigate complications in the fingers and hand after ARCR. We attempted to immediately detect and proactively treat these complications. We evaluated the outcomes of the early detection and treatment of the complications.

Results: Complications were observed in 17 hands (35%) and occurred an average of 1.5 months after ARCR. The symptoms in 3 hands resolved spontaneously, 2 hands were diagnosed with CTS, and 12 hands were diagnosed with TS. Of the 12 hands with TS, 11 exhibited no triggering of the fingers. Among the 14 hands diagnosed with CTS or TS, 13 hands (CTS: 2 hands, TS: 11 hands) were treated with corticosteroid injections; the mean interval between treatment initiation and symptom resolution was 1.0 months (0.5-3.0 months). None exhibited complex regional pain syndrome.

Conclusions: When symptoms occur in the fingers and hand after ARCR, CTS or TS should be primarily suspected. The diagnosis of TS must be made carefully because most patients with TS have no triggering. For patients with CTS or TS after ARCR, rapid corticosteroid injection administration can lead to improvement in these symptoms.

Keywords: Shoulder; arthroscopic rotator cuff repair; carpal tunnel syndrome; complex regional pain syndrome; finger; flexor tenosynovitis; hand; trigger finger.

Figure 1

Diagnosis, treatment, and treatment outcomes of complications in the fingers and hand after arthroscopic rotator cuff repair. CTS, carpal tunnel syndrome; TS, flexor tenosynovitis.

Figure 2

A 52-year-old male patient was treated with corticosteroid injections due to flexor tenosynovitis (TS) in the index finger on the operated side (right side) occurring at 2 months after arthroscopic rotator cuff repair. Before receiving the injection, on the operated side (right side), the patient experienced motion-induced finger pain, slight edema in the dorsal fingers and hand (before injection: A, nonoperated side, left side; B, operated side, right side), and movement limitation in the index finger (operated right side when fingers flexed before injection: C, front view; D, side view). We diagnosed these symptoms as TS in the index finger and administered corticosteroid injections. At 2 weeks after injection, the motion-induced pain and edema in the fingers and hand had disappeared, and the movement limitation in the index finger had improved (operated right side when fingers flexed at 2 weeks after injection: E, front view; F, side view). Furthermore, at 1 month after injection, the movement limitation in the index finger had completely resolved (operated right side when fingers flexed at 1 month after injection: G, front view; H, side view).