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Tuberculous Flexor Tenosynovitis with Median Nerve Compression: A Case Report.
Pushkar Khandekar1, Sandeep Patil1,2, Sujit Korday1,3
1Department of Orthopedics, V. N. Desai General Hospital, Mumbai, India.
JBJS Case Connector
|May 24, 2024
Summary
Tuberculosis can cause wrist swelling and median nerve compression, presenting as flexor tenosynovitis with rice bodies. Early diagnosis and antitubercular chemotherapy are crucial for effective treatment.
Area of Science:
- Orthopedics
- Infectious Diseases
- Rheumatology
Background:
- Flexor tenosynovitis of the wrist can present with non-specific symptoms like pain and swelling.
- Median nerve compression can lead to sensory and motor deficits in the hand.
- Rice bodies are pathognomonic for certain conditions but can be associated with various tenosynovitis types.
Observation:
- A 65-year-old female presented with right wrist pain, swelling, paresthesia, and thenar wasting.
- Magnetic resonance imaging revealed flexor tenosynovitis, median nerve compression, and multiple rice bodies.
- Excisional biopsy and median nerve decompression were performed.
Findings:
- Polymerase chain reaction (GeneXpert) detected Mycobacterium tuberculosis.
- Histopathology confirmed caseous granulomas, indicative of tuberculosis.
- Postoperative antitubercular chemotherapy was initiated.
Implications:
- Tuberculous flexor tenosynovitis should be considered in endemic regions, especially with wrist swelling and rice bodies.
- This case highlights the importance of considering infectious etiologies in tenosynovitis.
- Prompt diagnosis and treatment of tuberculous tenosynovitis are essential to prevent long-term nerve damage and functional impairment.
