Superior oblique tendon sheath syndrome and its relationship to stenosing tenosynovitis.

(4) As an attempt to explain specifically the intermittent cases, those associated with a clicking Found or sensation, and those showing spontaneous resolution, it has been suggested that there is a circumferential constriction of the trochlea and sheath preventing a locally enlarged tendon fi-om sliding freely in the sheath. This concept, first proposed by Girard (I956,1has been mentioned by other authors (Brown, i962b; Goldstein, I969; Sandford-Smith, I969; Catford and Dean Hart, I97I). The marked clinical similarity of the tendon sheath syndrome to the common orthopaedic condition of stenosing tenosyinovitis was first n-oted by Sandford-Smith (I969) and it was suggested that this may be the underlying pathological charge, not oily in the intermittent cases, but in the persistent ones. Mein (I97I), in a recent review of 37 cases, considered stenosing tenosynovitis to be the most likely cause of the tendon sheath syndrome. Hitherto, the evidence for this concept has been circumstantial, but two patients are described belowv wvhich give more direct evidence for this theory that the tendon sheath syndrome is a type of stenosing tenosynovitis. A third case is also described in which an attempt was made to carry out surgical treatment similar to that used for stenosing tenosynovitis in other parts of the body.