Tuberculous tenosynovitis of the flexor tendons of the wrist: a case report

Abstract

Background: Tuberculous tenosynovitis poses a significant public health challenge, especially in developing countries. It usually affects the flexor tendons of the wrist.

Case presentation: We present a case of a 65-year-old Ghanaian female. She presented a progressively enlarging mass over the volar aspect of the right wrist and palm. She did not have a previous history of tuberculosis. However, her erythrocyte sedimentation rate was high and Mantoux (purified protein derivative) test was strongly positive (more than 15 mm). Radiograph of ulna, radius, and wrist showed osteopenic changes around the distal radius. Excision biopsy of the mass was done and samples sent for histopathology comment. The findings were an inflamed, thickened synovia with rice bodies: suggestive of tuberculous tenosynovitis. Anti-tuberculous chemotherapy was commenced on the second postoperative day.

Conclusion: Tuberculous tenosynovitis of the wrist is uncommon. However, in developing countries like Ghana where tuberculosis is prevalent, it should be part of the differential diagnosis of compound palmar ganglion in order to prevent delayed diagnosis and treatment.

Keywords: And flexor tendon sheath; Compound palmar ganglion; Melon bodies; Rice bodies.

Fig. 1

Clinical picture showing compound palmar ganglion

Fig. 2

X-ray of the distal radius/ulna with the wrist showing localized osteopenia around the radiocarpal joint

Fig. 3

Single fluctuant mass

Fig. 4

Clinical picture showing rice bodies

Fig. 5

Total synovectomy done

Fig. 6

One year after surgery and there is no evidence of recurrence

Fig. 7

One year after surgery