Tuberculous tenosynovitis of hand and wrist: a report of two cases

Tuberculous tenosynovitis of the wrist and hand is a rare condition that presents as chronic painless swelling, tenosynovitis and occasional compressive neuropathy. There is usually a striking lack of pulmonary symptoms. Two patients of tuberculous tenosynovitis of wrist and hand, who were managed at a tertiary health care centre, are presented. Both were young healthy adult males with isolated tenosynovitis of one hand each, without any associated systemic or pulmonary features. Both had been reviewed earlier at other tertiary referral centers without establishing the correct diagnosis. They presented with painful swelling in the wrist and palm. One patient also had features of ulnar nerve compressive neuropathy. Intra-operatively, both had thickened synovium of flexor tendons with "rice bodies" within the synovial fluid. Surgical management consisted of synovectomy and decompression of the nerves. Post-operatively, both were given full anti-tubercular treatment. On follow-up of over three years, they have remained free from recurrence. The slow progressive course of clinical symptoms and lack of radiological signs of tuberculosis leads to difficulties in establishing early diagnosis of this rare localized tuberculous infection. The functional outcome depends on early diagnosis and surgical intervention for symptomatic patients, thus emphasizing the importance of awareness of this rare entity.