Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases.

Abstract

All imaging methods can provide complementary information that is helpful for determination of therapy. MR imaging seems to be superior in evaluating the extent of the lesion, particularly in soft tissue.

Extensors tenosynovitis of wrist with rupture of extensor digitorum: rare presentation of tuberculosis

“…However, the digital flexor sheaths and the dorsal wrist compartment are affected less often. [4][5][6][7] Multifocal tenosynovitis has been reported recently. 7 The mechanism may be direct inoculation from adjacent bone or joint infection or seeding from a tuberculous lesion in the pleuropulmonary or genitourinary system.…”

“…Patients may present with discharging sinus and carpal tunnel syndrome. 5,8 Tendon rupture is a rare presentation, but it may occur when treatment is delayed. 5,9 The onset of disease is gradual with slow progression leading to welladvanced disease before presentation, as in our patient.…”

“…5,8 Tendon rupture is a rare presentation, but it may occur when treatment is delayed. 5,9 The onset of disease is gradual with slow progression leading to welladvanced disease before presentation, as in our patient. Mason, quoting from Kanavel's files, reports that, out of 21 available records of tuberculous tenosynovitis in the hand, rupture or impending rupture of the tendon was noted in 10 instances.…”

“…This may lead to sinus formation and superimposed secondary infection. 5,[9][10][11] Although granulomas (Caseating and non-caseating) occur in most cases "Rice bodies" or "Melon seeds" represent fibrinousmasses (Tubercles) which are present in 50% of TB cases. 11,12 Laboratory findings are generally negative, except for the erythrocyte sedimentation rate, which is usually increased.…”

“…Differential diagnoses of tuberculous tenosynovitis include other mycobacterial infections, pyogenic infection, brucellosis, foreign body tenosynovitis, sarcoidosis, rheumatoid arthritis, gouty arthritis, pigmented villonodular synovitis of the tendon sheath, and fungus infection. 5,[11][12][13] The most effective treatment involves a combination of medical and surgical therapies. 5,6,10,11 Rifampicin, isoniazid, pyrazinamide, and ethambutol are prescribed.…”