Injection Technique for Secretan Syndrome

Indications and Clinical Considerations

Secretan syndrome is caused by a peritendinous fibrosis that occurs after trauma to the dorsum of the hand. Often the traumatic event is seemingly minor, such as hitting the back of the hand on the corner of a desk. Initially, the swelling and tenderness may be attributed to the trauma, but instead of improving with time, the dorsum of the hand becomes more indurated, with the edema becoming brawny. If the syndrome is not treated, peritendinous fibrosis and an almost myxedematous hardening of the soft tissues of the dorsum of the hand occur ( Figs. 96.1 and 96.2 ). Like the pain of Dupuytren contracture, the pain of Secretan syndrome seems to burn itself out as the disease progresses.

Arthritis, gout of the metacarpal and interphalangeal joints, and tendinitis may coexist with and exacerbate the pain and disability of Secretan syndrome. Reflex sympathetic dystrophy may manifest in a similar clinical manner but can be distinguished from Secretan syndrome by the fact that the pain of reflex sympathetic dystrophy responds to sympathetic neural blockade, whereas the pain of Secretan syndrome does not.

Plain radiographs are indicated for all patients with Secretan syndrome to rule out underlying occult bony disease. On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, uric acid, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging of the hand is indicated if joint instability or tumor is suspected and to help confirm the diagnosis ( Fig. 96.3 ). Electromyography is indicated if coexistent ulnar or carpal tunnel syndrome is suspected. The injection technique described later provides improvement of the pain and disability of this disease if implemented early.