Tubercular Tenosynovitis of Hand: A Rare Presentation

• Published in: Journal of orthopaedic case reports 2016-09, Vol.6 (4), p.69
• Main Authors: Jain, Aditya, Rohilla, Rajesh, Devgan, Ashish, Wadhwani, Jitendra
• Format: Article
• Language: English
• ISSN: 2250-0685
• DOI: 10.13107/jocr.2250-0685.576

Tuberculosis tenosynovitis of the wrist and hand is an unusual condition. It mimics a number of other clinical conditions such as ganglion, De quervan's disease, carpal tunnel syndrome, granulomatous gout, neurofibroma, and haemangioma. We present case of 58-year-old male patient with swelling over thenar region of left hand where the initial fine needle aspiration cytology (FNAC) report suggested diagnosis of ganglion/synovial cyst, but the patient did not improve with conservative treatment. FNAC was repeated which showed granulomatous inflammation consistent with the clinical diagnosis of tuberculosis and antitubercular therapy for 9 months was given. Swelling disappeared and normal range of movements was attained in adjacent joints at final follow-up of 12 months from initiation of antitubercular treatment (ATT). The literature on the management of tubercular tenosynovitis has mostly incorporated surgical method as one of the first-line treatments. We report an unusual case, where the tenosynovitis of wrist completely responded within 12 months of ATT without any need of surgical treatment.