Extensors tenosynovitis of wrist with rupture of extensor digitorum: rare presentation of tuberculosis
Keywords:Extensor tenosynovitis, Tuberculosis, Hand
Majority of the non-pulmonary TB are seen in musculo skeletal system. It’s a chronic and progressive disease that mostly affects weight bearing joints. Upper extremity presentations are not common. Tendon sheaths constitute an uncommon target of extra articular tuberculosis. Tubercular tenosynovitis is now rare, which can delay diagnosis of this disease. Authors report a case of Tuberculosis Tenosynovitis affecting dorsum of hand with pathological rupture of extensor digitorum. A 60 year old male patient present with a progressive swelling over the dorsum of right wrist of 4 month duration. Later he was taken for open excision biopsy. Melon-seed bodies were found inside the exensor tendon sheath with complete rupture of extensor tendon. Case was managed by extensor sheath were excised and removed in total thorough irrigation of the wound was done, retinaculum is repaired, extensor tendons repaired. Histopathology confirmed Tuberculosis. Although the tendon sheath constitutes an uncommon target of extra articular TB, it is one of the leading causes of chronic tendon sheath infection. Hence should be considered in the differential diagnosis of hand masses.
Albornoz MA, Mezgarzedeh M, Neumann CH. Myers Granulomatous tenosynovitis: a rare musculoskeletal manifestation of tuberculosis. Clin Rheumatol. 1998;17:166-9.
Lee SH, Abramson SB. Infections of the musculoskeletal system by M. tuberculosis. In: Rom WN, Garay SM, eds. Tuberculosis. 4th ed. New York, NY: Little, Brown and Company; 1996: 635-644.
Fnini S, Ouarab M, Rafai M, Cohen D, Largab A, Trafeh M. An uncommon occupational accident: tuberculous tenosynovitis of the extensor of the hand. Chir Main. 1999;18:309-12.
Bickel WH, Kimbrough RF, Dahlin DC. Tuberculous tenosynovitis. J Am Med Assoc. 1953;151(1):31-5.
Jaovisidha S, Chen C, Ryu KN, Siriwongpairat P, Pekanan P, Sartoris DJ, et al. Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases. Radiology. 1996;201:507-13.
Pimm LH, Waugh W. Tuberculous tenosynovitis. J Bone Joint Surg Br. 1957;39-B(1):91-101.
Mason ML. Tuberculous tenosynovitis of the hand. A study of thirty-three cases of tuberculous tenosynovitis. Surg Gynecol Obstet. 1934;59:363-9.
Amine B, Benbouazza K, Bahiri R, Hajjaj-Hassouni N. Multifocal tuberculous tenosynovitis. Joint Bone Spine. 2006;73(4):474-5.
Burkhardt E. Chronic diseases of the synovial sheath (from hand surgery consulting hour). Beitr Orthop Traumatol. 1972;19:377-91.
Kanavel AB. Tuberculous tenosynovitis of the hand: a report of fourteen cases of tuberculous tenosynovitis. Surg Gynecol Obstet. 1923;37:635-47.
Aboudola S, Sienko A, Carey RB, Johnson S. Tuberculous tenosynovitis. Hum Pathol. 2004;35(8):1044-6.
Hoffman KA, Bergman AG, Hoffman DK, Harris DP. Tuberculosis tenosynovitis of the flexor tendons of the wrist: MR imaging with pathologic correlation. Skeletal Radiol. 1996;25:186-8.
Hsu CY, Lu HC, Shih TT. Tuberculous infection of the wrist: MRI features. AJR Am J Roentgenol. 2004;183(3):623-8.
Skoff HD. Postfracture extensor pollicis longus tenosynovitis and tendon rupture: a scientific study and personal series. Am J Orthop. 2003;32(5):245-7.
Hodgson AR, Smith TK, Sister G. Tuberculosis of the wrist. With a note on chemotherapy. Clin Orthop Relat Res. 1972;83:73-83.
Regnard PJ, Barry P, Isselin J. Mycobacterium tenosynovitis in the flexor tendons of the hands: a report of five cases. J Hand Surg Br. 1996;21(3):351-4.