Utility of Routine Histopathologic and Culture Analysis in Wrist Tenosynovectomy

PURPOSE: Routine practices without a clear impact on patient care merit continuous reassessment. This retrospective study evaluated the value of routine histopathologic and culture analysis in patients who underwent flexor or extensor tendon tenosynovectomy. METHODS: Current Procedural Terminology codes for isolated tenosynovectomy procedures were queried from an institutional database from 2018 to 2023, including all patients aged ≥18 treated by one of seven fellowship-trained hand surgeons. Demographics, past medical and surgical history, clinic notes, operative notes, imaging, pathology, and culture data were reviewed. We assessed for changes to the treatment course of each patient based on the pathology and culture data. RESULTS: A total of 57 patients were assessed histologically including 20 patients with known inflammatory conditions; histopathology did not alter the care of any of those 20 patients. One of the remaining 37 patients was referred to rheumatology and ultimately diagnosed with rheumatoid arthritis. A total of 50 patients were assessed by microbiology; when infection was suspected before surgery or intraoperatively, cultures were positive in 74% of cases. One of the 27 patients without a suspicion for infection tested positive for Mycobacterium marinum complex infection, altering the patient's care. CONCLUSIONS: In patients with a known inflammatory condition, routine histopathologic analysis of tenosynovium did not alter patient care; based on these findings, we no longer routinely assess this tissue in these patients. Histopathology assessment in patients without an underlying diagnosis of inflammatory conditions and culture in patients without suspicion for infection altered care only rarely. In these groups, we recognize the likely negative evaluation but continue to assess biopsied tissues as positive tests will alter patient care. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.