Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist

Abstract

The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery.

Isolated Tuberculosis of Capitate and Triquetrum

“…Chest X-ray is usually normal in cases of hand tuberculosis. 6,8,9 It is important for physicians to keep in mind that tuberculosis of the bone and joint can be a primary, isolated lesion. Chest Xray was negative, as is the case in two-third of the patients with bone tuberculosis.…”

“…Because of this, smears, Ziehl-Nelson stains, and tuberculosis cultures in Lowenstein-Jensen (Salubris AŞ, İstanbul) and BACTEC media (Becton Dickinson, Sparks Glencoe, MD) are frequently negative in extrapulmonary tuberculosis. 2,9 Therefore, negative results in micro-scopic evaluation should not exclude the diagnosis of tuberculosis in endemic areas with typical clinical, radiological, and histopathological features. 2,9 In regions where tuberculosis is not endemic, histopathologic or microbiologic confirmation should be mandatory.…”

“…2,9 Therefore, negative results in micro-scopic evaluation should not exclude the diagnosis of tuberculosis in endemic areas with typical clinical, radiological, and histopathological features. 2,9 In regions where tuberculosis is not endemic, histopathologic or microbiologic confirmation should be mandatory. 8 In this case tuberculosis was even harder to suspect, due to some unique features.…”

“…4,10 Tuberculous bacilli are rarely seen (with Ziehl-Neelsen staining) or grown in culture, and the diagnosis often has to be made based on the granulomatous appearance histologically along with high clinical and radiographic suspicion. 4,8,9 Although surgical debridement is controversial for hand and wrist tuberculosis. 2,5,6,9 Some authors suggests that management is essential by conducting a bony debridement combined with antitubercular drugs, rest of the involved part in functioning position and early active exercise.…”

“…4,8,9 Although surgical debridement is controversial for hand and wrist tuberculosis. 2,5,6,9 Some authors suggests that management is essential by conducting a bony debridement combined with antitubercular drugs, rest of the involved part in functioning position and early active exercise. 4,7,11 Because early osteoarticular tuberculosis heals without significant residual problems.…”