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Lui TH, Leung OT. Endoscopic Resection of Ulnar Bursa of the Palm: 2 Ulnar Portals Technique. Arthrosc Tech 2023; 12:e1765-e1771. [PMID: 37942104 PMCID: PMC10627874 DOI: 10.1016/j.eats.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 11/10/2023] Open
Abstract
Ulnar bursa of the hand invaginates the flexor digitorum superficialis and flexor digitorum profundus tendons of the little, ring, long, and index fingers. Distension of this bursa can have an inflammatory or infective cause. It can also originate from pathology of another site (e.g., degenerative wrist joint). Because of the tough overlying palmar aponeurosis, distended ulnar bursa can have swelling at a remote site. The distended ulnar bursa can also have compressive neuropathy to the ulnar nerve and median nerve. The purpose of this Technical Note is to describe the technical details of the 2 ulnar portals technique involving endoscopic resection of the ulnar bursa. This is indicated for symptomatic distension of the ulnar bursa, especially with hypothenar extension.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
| | - Odin Tymon Leung
- Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong SAR, China
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2
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Ngoc CT, Tuan NC, Thinh NP, Duc NM. Clinical characteristics and treatment outcomes of tuberculous tenosynovitis of the hand and wrist. Int J Med Sci 2023; 20:985-992. [PMID: 37324187 PMCID: PMC10266042 DOI: 10.7150/ijms.84727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Objective: Vietnam is endemic with tuberculosis (TB), which is highly prevalent in the community. TB tenosynovitis of the wrist and hand is uncommon. Because of its insidious progression and atypical presentations, it is often difficult to diagnose, leading to treatment delays. This study investigates the characteristics of clinical and subclinical signs and treatment outcomes of patients with TB tenosynovitis in Vietnam. Patients and Methods: This prospective longitudinal cross-sectional study included 25 TB tenosynovitis patients in the Rheumatology Clinic at University Medical Center Ho Chi Minh City. The diagnosis was made based on a tuberculous cyst in histopathological specimens. The data were collected through medical history, physical examination, and medical records, including demographics, signs, symptoms, condition duration, and related laboratory tests and imaging. The outcomes of all participants were assessed after 12 months of treatment. Results: The most common symptom of TB tenosynovitis was swelling of the hand and wrist, which was present in all patients. Its other symptoms included mild pain and numbness of the hand in 72% and 24% of patients, respectively. It can affect any site on the hand. Hand ultrasound findings included thickening of the synovial membrane (80%), peritendinous effusion (64%), and soft tissue swelling (88%). Most patients (18/22) had a good outcome after the treatment with anti-tubercular drugs. Conclusions: TB tenosynovitis progression is often insidious. Its most common symptoms are swelling of the hand and mild pain. Ultrasound is a useful tool to support the diagnosis. A histological examination confirms the diagnosis. Most cases respond and have a good outcome after 9-12 months of anti-tuberculosis treatment.
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Affiliation(s)
- Cao Thanh Ngoc
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Rheumatology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Chau Tuan
- Department of Rheumatology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Phuc Thinh
- Department of Orthopedics, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Giri SK, Suba S, Bandyopadhyay A, R P. Tuberculous flexor tenosynovitis of wrist and hand. BMJ Case Rep 2023; 16:e252286. [PMID: 36944442 PMCID: PMC10032381 DOI: 10.1136/bcr-2022-252286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
A woman in her 40s presented with a swelling over her left distal forearm and hand since 7 months, progressively increasing in size. She had history of difficulty in moving her wrist and fingers with no associated pain. She had no immune or chronic conditions except for hypothyroidism for which she was on regular medication. On examination, there was an 8×7 cm swelling on the radial side of the volar surface of her left distal forearm extending till the thenar eminence. MRI of the left upper limb was suggestive of a soft tissue swelling arising from the flexor tendon.The patient was planned for surgical excision of the swelling. Intraoperatively, there was a mass arising from the flexor tendons of flexor digitorum superficialis, flexor digitorum profundus (FDP) and flexor pollicis longus (FPL), extending distally up to the mid palm region. On incising the flexor tendon sheath, it was observed that multiple yellowish rice like granules extended across the tendons. The lesion was excised completely and sent for histopathology examination. The lax FDP of little and ring fingers were plicated following proper tension adjustment and defect in FPL was primarily repaired. Postoperatively, the patient recovered well with no local wound complications. The biopsy report was suggestive of tuberculosis. The patient completed a course of antituberculosis treatment in 6 months.
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Affiliation(s)
- Sanjay Kumar Giri
- Burns and Plastic Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Santanu Suba
- Burns and Plastic Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | | | - Pavithra R
- Burns and Plastic Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Chaudhary S, Maji S, Garg V, Singh V. Isolated multidrug-resistant tubercular tenosynovitis of the flexor tendon of the little finger. BMJ Case Rep 2021; 14:14/2/e238339. [PMID: 33608337 PMCID: PMC7896614 DOI: 10.1136/bcr-2020-238339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.
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Affiliation(s)
- Sunny Chaudhary
- Department of Orthopedics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, India
| | - Subhajit Maji
- Department of Orthopedics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, India
| | - Varun Garg
- Department of Orthopedics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences - Rishikesh, Rishikesh, India
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Lui TH, Lee JCY. Endoscopic Synovectomy of the Ulnar Bursa of the Palm of the Hand. Arthrosc Tech 2018; 7:e1257-e1261. [PMID: 30591871 PMCID: PMC6305889 DOI: 10.1016/j.eats.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023] Open
Abstract
Synovitis of the ulnar bursa is associated with tenosynovitis of the flexor tendons. Reported causes include suppurative or tuberculous infection, rheumatoid arthritis, and pigmented villonodular synovitis. Open synovectomy requires extensive soft-tissue dissection and may result in extensive scarring. The purpose of this Technical Note is to describe the technical details of endoscopic synovectomy of the ulnar bursa of the palm of the hand. This minimally invasive approach with small incisions allows aggressive postoperative hand therapy and avoids the complications of tendon adhesions, joint contractures, and hand stiffness.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, China,Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China
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Flexor Tenosynovitis of the Hand Caused by Mycobacterium tuberculosis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e083. [PMID: 30211389 PMCID: PMC6132321 DOI: 10.5435/jaaosglobal-d-17-00083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Infectious tenosynovitis of the hand is a serious condition with a high risk of morbidity. Mycobacterium tuberculosis is a rare cause of tenosynovitis, especially in regions where tuberculosis is no longer endemic, and presents significant diagnostic challenges. We present the case of a 42-year-old woman with no known history of or exposure to tuberculosis and a medical history of systemic lupus erythematosus on chronic immunosuppressive therapy who presented with swelling and erythema in the fifth finger of the left hand of 1-month duration. She underwent tenosynovectomy, and intraoperative cultures grew M tuberculosis. The patient completed an appropriate antibiotic regimen, and systemic workup revealed ring-enhancing lesions on brain MRI consistent with tuberculoma. We review the literature and current trends in the management of mycobacterial tenosynovitis, as well as the important teaching points of the case.
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Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative? Ann Plast Surg 2017; 77:169-72. [PMID: 26418769 DOI: 10.1097/sap.0000000000000603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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.
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Corominas H, Reina D, Torrente-Segarra V, Chico C, Antón V, Estrada P, Navarro V. Suitability of High-resolution Ultrasound-guided Puncture in the Diagnosis of a Soft Tissue Mass Infected With Mycobacterium tuberculosis. ACTA ACUST UNITED AC 2017; 14:171-172. [PMID: 28209397 DOI: 10.1016/j.reuma.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Hèctor Corominas
- Servei de Reumatologia, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España.
| | - Dèlia Reina
- Servei de Reumatologia, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España
| | - Vicenç Torrente-Segarra
- Servei de Reumatologia, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España
| | - Cristina Chico
- Servei de Medicina Interna, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España
| | - Vanessa Antón
- Servei de Medicina Interna, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España
| | - Paula Estrada
- Servei de Reumatologia, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España
| | - Vanessa Navarro
- Servei de Reumatologia, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España
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Sbai MA, Benzarti S, Boussen M, Maalla R. Tuberculous flexor tenosynovitis of the hand. Int J Mycobacteriol 2015; 4:347-9. [DOI: 10.1016/j.ijmyco.2015.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022] Open
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Weber E, Gagneux-Brunon A, Jacomo V, Rousselon T, Lucht F, Botelho-Nevers E. Tenosynovitis: a rare presentation of tuberculosis better known by hand surgeons than infectious diseases specialists. Infection 2015; 43:261-6. [PMID: 25690847 DOI: 10.1007/s15010-015-0741-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Clinical presentation of tuberculosis is pleomorphic. Some forms are rare and better known by surgeons than infectious disease specialists. METHODS We describe a rare case of isolated chronic tenosynovitis of the wrist due to Mycobacterium tuberculosis in a 66-year-old man and review similar cases in the literature. RESULTS On literature search, only 23 other cases of tuberculous tenosynovitis were retrieved. Our case is similar, with an insidious classical presentation. The diagnosis was suggested at the surgical presentation by the presence of rice body masses. CONCLUSION The diagnosis of tuberculous tenosynovitis should be considered in chronic tenosynovitis. Functional prognosis may be committed without adequate treatment.
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Affiliation(s)
- Emmanuelle Weber
- Infectious Diseases Department, University Hospital, 42055, Saint-Etienne Cedex 2, France
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Ben Abdelghani K, Maatallah K, Ajili F, Souabni L, Laatar A, Zakraoui L. [Rare localization of tuberculosis: tenosynovitis of the fingers]. Pan Afr Med J 2014; 17:270. [PMID: 25317223 PMCID: PMC4191706 DOI: 10.11604/pamj.2014.17.270.3807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/15/2014] [Indexed: 11/11/2022] Open
Abstract
La ténosynovite tuberculeuse est une localisation rare de la tuberculose. Le diagnostic en est souvent tardif en raison de manifestations cliniques souvent pauvres et chroniques. Nous rapportons une observation de ténosynovite tuberculeuse du 2ème rayon de la main droite d’évolution favorable sous traitement antituberculeux.
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Affiliation(s)
- Kaouther Ben Abdelghani
- Service de Rhumatologie, Hôpital Mongi Slim La Marsa, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Kaouther Maatallah
- Service de Rhumatologie, Hôpital Mongi Slim La Marsa, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Faida Ajili
- Service de Médecine Interne, Hopital Militaire de Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Leila Souabni
- Service de Rhumatologie, Hôpital Mongi Slim La Marsa, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Ahmed Laatar
- Service de Rhumatologie, Hôpital Mongi Slim La Marsa, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Leith Zakraoui
- Service de Rhumatologie, Hôpital Mongi Slim La Marsa, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
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