Wrist synovectomy confirmed tuberculous tenosynovitis in 8 cases: A follow-up study

Abstract

Aim of the workTuberculosis is still one of the important health problems. Because of its insidious evolution, tuberculous (TB) tenosynovitis (TS) is usually misdiagnosed and undertreated. The aim of this study was to investigate clinical and therapeutic outcomes of TB TS. Patients and methodsA retrospective study of 8 patients followed-up for TB TS was conducted. Clinical and therapeutic data were collected. ResultsThe median age was 45years (range 33–59years), they were 5 females and 3 males with a median duration till diagnosis of 15months. Fever, night sweats, and weight loss were reported by 3 patients. Physical examination showed swelling of the wrist and crepitation of the palmar side with affected fingers movements in 7 cases. A carpal tunnel syndrome was found in another case. The median erythrocyte sedimentation rate was 15mm/1st hour and the C-reactive protein 5mg/dl. Plain radiographies of the wrists were normal. Ultrasonography showed flexor TS in all cases. Since tuberculin skin tests were positive in all patients, TB TS was suspected. Surgical synovectomy was conducted and histological examination confirmed TB. In addition to surgical synovectomy, patients were treated with anti-TB drugs for 12months. No relapse was noted for a mean follow-up duration of 2years. ConclusionsTB TS can be misdiagnosed because of its insidious evolution. Histological examination confirms the diagnosis. Surgical synovectomy could confirm the diagnosis rapidly by the histological examination and be part of the treatment. Medical treatment should be well-conducted and maintained to avoid relapse and future complications.