Tuberculous Tenosynovitis Presenting As Ganglion Of Wrist

Abstract

Tuberculosis (TB) is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. 57 years old male presented with swelling over the left wrist since 3 years. Three swellings over dorsal aspect of the left wrist, soft in consistency, non tender, non compressible mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigation were normal. Ultrasonography showed Giant-cell tumor of Extensor Digitorum sheath. Xray: soft tissue swelling MRI suggestive of Extensor Tendon sheath Extraskeletal Synovial Koch's or Giant cell tumor of tendon sheath. Then planed for excision of swelling and intra-operative fi nding were rice bodies. Histopathological examination showed caseous necrosis with granuloma formation. Patient put on DOT1 therapy. Tuberculous tenosynovitis was fi rst described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were fi rst described in 1895 by Reise Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with Extensive curettage, lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the signifi cance of loose bodies when performing routine excision of innocuous looking wrist ganglia.

Rice Bodies Accompanied by Tenosynovitis of the Wrist: A Case Report and Literature Review

“…However, the presence of rice bodies in the wrist is less common [1,3,4]. We carried out a thorough database search through PubMed (with the search query: "rice bod*" AND wrist) to identify all similar case reports in the literature (Tables 1, 2) [1,[4][5][6][7][8][9][10][11][12]. In terms of clinical presentation, our case was quite similar to cases observed in the literature, highlighted by a mass that enlarges progressively with time.…”

“…In terms of clinical presentation, our case was quite similar to cases observed in the literature, highlighted by a mass that enlarges progressively with time. The presentation is acute (less than six months) [1,3,7] in some cases and chronic in others (more than six months) [6,[9][10][11][12], and thus, some patients present with painful masses, while others present with painless masses. There is no trend in regard to laterality, as some cases present with masses in the right or left wrist [1,5,[11][12][13].…”

Omitting histopathology in wrist ganglions. A risky proposition

“…Delay in treatment, or repeat surgery may be required if these diagnoses are missed by omitting histopathological examination. 6 , 7…”

“… 4 , 5 However, there are recent case reports from our region, where tuberculosis (TB) is endemic, showing that tuberculous tenosynovitis presented as a wrist ganglion with subtle intraoperative finding of thickened synovium. 6 , 7 As TB is still prevalent in our part of the world, we decided to review the histopathology of wrist ganglia excised at our institute to study the incidence of TB and other conditions mimicking ganglia.…”