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.
Introduction:The quadriga phenomenon results from excessive shortening of the flexor digitorum profundus (FDP) tendon to the middle, ring, or small finger.Methods:Five cadaveric specimens were used to create a model for quadriga. The FDP tendons to the middle, ring, and small fingers were shortened in 5-mm increments, and the tip-to-palm (TTP) distance of adjacent fingers was recorded.Results:Shortening of the middle finger FDP by 10 mm resulted in an average TTP distance of 6 mm in the ring finger and 5 mm in the small finger. Shortening the ring finger FDP by 10 mm produced an average TTP distance of 11 mm in the middle finger and 9 mm in the small finger. Shortening of the small finger FDP by 10 mm resulted in an average TTP distance of 14 mm in the middle finger and 10 mm in the ring finger.Discussion:Shortening the FDP by as little as 10 mm produced a significant quadriga effect, which was more pronounced with shortening of the small and ring FDP tendons compared to the middle finger.
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