Peritendinitis crepitans and simple tenosynovitis; a clinical study of 544 cases in industry.

This paper deals with simple or traumatic tenosynovitis as distinct from pyogenic or granulomatous affections of the tendon sheaths. Literature on the subject in this country is scanty, and lacking in a clear understanding of the underlying pathology, for although in the pyogenic group a true infection of the tendon sheath is present, this is not always so in simple tenosynovitis, and it is unfortunate that the nomenclature of each should remain the same. Although true tenosynovitis may occur in other regions, the one most commonly affected in simple " tenosynovitis " is the dorsum of the forearm proximal to the wrist joint. Standard works on surgery continue to refer to it as " tenosynovitis", but as the lesion responsible is well above the upper limit of the tendon sheaths themselves, we would prefer the name " peritendinitis crepitans" as being more truly descriptive. Tenosynovitis is a well known cause of industrial disability, but, except in the mining community, its occupational significance has never been fully appreciated. In certain circumstances, its incidence may be high as during the war years when many people, recruited for work in factories for the first time, were engaged in unaccustomed tasks involving speed and intensity of effort (Reed and Harcourt, 1943; Blood, 1942). Tenosynvotis, however, is by no means confined to factory workers. It has been reported among agricultural workers and others (Pozner, 1942; Flowerdew and Bode, 1942; Taylor-Jones, 1942). The present study is concerned mainly with the condition as it affects the wrist and forearm of the manual worker in industry (peritendinitis crepitans), but an additional series of true tenosynovitis cases involving tendon sheaths in other situations is also considered. If it is not diagnosed and treated -promptly, tenosynovitis can cause much needless absenteeism and continuing disability, and at one factory (Vauxhall Motors) employing 12,000 persons medical records in the past show that about 40 cases occur annually, with an average absence of 21 days.