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Basnayake O, Jayarajah U, Beneragama T. Tuberculosis of the wrist causing carpal tunnel syndrome in a patient with rheumatoid arthritis: A case report. SAGE Open Med Case Rep 2024; 12:2050313X231225871. [PMID: 38222941 PMCID: PMC10787524 DOI: 10.1177/2050313x231225871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024] Open
Abstract
Among extrapulmonary tuberculosis, osteoarticular tuberculosis is a rare manifestation, and cases related to osteoarticular tuberculosis of large joints have been reported previously. However, tuberculous tenosynovitis causing carpal tunnel syndrome is a rare manifestation, especially in the background of rheumatoid arthritis. A 67-year-old Sri Lankan male with a background of rheumatoid arthritis presented with progressively enlarging left wrist swelling associated with pain and numbness for 2 months. He was on Methotrexate and Hydroxychloroquine as disease-modifying agents, and his symptoms related to arthritis were well controlled. On examination, lobulated subcutaneous swelling was noted in distal forearm extending to the palmar region with evidence of carpal tunnel syndrome which was confirmed by nerve conduction studies. There was no pre-operative evidence to suggest tuberculosis both clinically and biochemically. Synovial thickening due to rheumatoid arthritis was considered as the probable diagnosis and surgical decompression of the carpal tunnel was performed. Intraoperatively, synovial thickening was noted around the flexor tendons with evidence of median nerve compression in the carpal tunnel. Thickened synovial mass was completely excised. Histology and culture were positive for tuberculosis. Following excision and 9 months of anti-tuberculosis treatment, he was asymptomatic with good range of motion of fingers. In conclusion, a combination of surgical excision and anti-tuberculosis treatment was successful to achieve good functional outcomes. In a country like Sri Lanka, where tuberculosis is still prevalent, uncommon musculoskeletal manifestations may not be infrequent. Therefore, clinicians should have a high degree of suspicion when treating such patients.
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Affiliation(s)
- Oshan Basnayake
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Plastic and Reconstructive Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Umesh Jayarajah
- Department of Plastic and Reconstructive Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Thushan Beneragama
- Department of Plastic and Reconstructive Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
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2
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Singh M, Jeyaraman M, Jeyaraman N, Jayakumar T, Iyengar KP, Jain VK. Mycobacterium Tuberculosis infection of the wrist joint: A current concepts review. J Clin Orthop Trauma 2023; 44:102257. [PMID: 37841656 PMCID: PMC10568419 DOI: 10.1016/j.jcot.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/09/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023] Open
Abstract
Background Osteoarticular Tuberculosis (TB) of wrist joint is a rare, often misdiagnosed form of site affected by Mycobacterium Tuberculosis infection that can lead to severe disability and morbidity. This review aims to summarize the current literature on the diagnosis and management of Mycobacterium Tuberculosis infection of the wrist joint. Materials and methods A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted on PubMed, Google Scholar, and Web of Science databases from 1967 to 2022, excluding single case reports and correspondence articles. The keywords used for the search included 'Mycobacterium tuberculosis' 'osteoarticular' and 'wrist'. Clinical presentation, demographic details, complementary investigations undertaken, trends, and complications of different management interventions were recorded to generate this review. Results Osteoarticular Tuberculosis (TB) of the wrist joint accounts for fewer than 1% of all skeletal TB cases across a spectrum of age ranges. Magnetic Resonance Imaging (MRI) represents an excellent modality to reveal the extent of the disease at an early stage of the condition. Synovial fluid analysis has been recommended for microbiological diagnosis. Treatment options include anti-tubercular therapy (ATT), incision and drainage, debridement, synovectomy, and arthrodesis. Conclusion Early diagnosis and treatment of wrist tuberculosis is crucial for achieving good functional outcomes in patients with this uncommon condition. Polymerase Chain Reaction (PCR) and GeneXpert technology for the detection of Mycobacterium tuberculosis (MTB) have improved diagnostic accuracy in detecting MTB DNA and rifampicin resistance. Anti-Tubercular Therapy (ATT) regime remains a foundation pillar in the overall management of these patients with focused surgical interventions leading to improved clinical outcomes.
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Affiliation(s)
- Mohit Singh
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Tarun Jayakumar
- Department of Orthopaedics, KIMS-Sunshine Hospital, Hyderabad, 500003, Telangana, India
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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3
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Abdulrahman BB, Aziz JMA, Salih MKB, Rashid MJ, Ahmed ML, Awl RH, Rauf SB, Ali HHH, Huy NT, Rasheed MK. Recurrence of tuberculous tenosynovitis in wrist tendon of a butcher: rare case report. J Surg Case Rep 2023; 2023:rjad353. [PMID: 37564055 PMCID: PMC10409645 DOI: 10.1093/jscr/rjad353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 08/12/2023] Open
Abstract
Diagnosing of tuberculous arthritis can be challenging due to its insidious onset and non-specific clinical presentation. A high index of suspicion is required for early diagnosis. A 54-year-old butcher was admitted to an orthopedic clinic with complaints of pain, paresthesia and an enlarging mass in the left wrist, which limited finger flexion. Initially the patient was diagnosed with carpal tunnel syndrome (CTS); the patient had no history of tuberculosis (TB), but had direct contact with animals. On clinical examination, a small mass was found in the distal volar region of the forearm and no lymphadenopathy was observed. Despite the diagnosis the patient refused to receive TB treatment. After a period of 4 months, the patient once again exhibited symptoms of CTS. This case highlights the importance of considering TB as a potential etiology for persistent symptoms of carpal tunnel surgery. Early diagnosis and prompt initiation of TB treatment can result in favorable outcomes and can prevent future recurrence.
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Affiliation(s)
| | - Jeza Muhamad Abdul Aziz
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, Kurdistan Region, Iraq
- Biomedical Science Department, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region, Iraq
| | | | | | - Mohammed Latif Ahmed
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
| | - Ramyar Hersh Awl
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
| | - Shanga Baram Rauf
- Medical Laboratory Department, College of Health and Medical Technology, Sulaimani Polytechnic University, Sulaymaniyah, Kurdistan Region, Iraq
| | - Harem Habil Hama Ali
- College of Veterinary Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Mariwan Kadir Rasheed
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, Kurdistan Region, Iraq
- Medical Laboratory Science, College of Health Sciences, University of Human Development, Sulaimaniyah, Kurdistan Region, Iraq
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4
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Agarwal A, Pandey SD, Khare A. Peripheral Tubercular Neuritis: A Case Report. J Hand Surg Am 2023; 48:515.e1-515.e5. [PMID: 36922292 DOI: 10.1016/j.jhsa.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/15/2023] [Accepted: 02/01/2023] [Indexed: 03/18/2023]
Abstract
Peripheral neuropathy can affect sensory, motor, or autonomic nerves and manifest with a variety of symptoms. Tuberculosis as a major infectious disease that often affects many organs of the body. However, primary involvement of peripheral nerves is unusual. Peripheral neuropathy in patients with tuberculosis often is associated with other comorbidities, such as immunocompromised states, diabetes mellitus, malnutrition, and some antitubercular medications. This report describes the rare finding of peripheral tubercular neuritis with caseating abscesses of right median and radial nerve in a healthy 24-year man.
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Affiliation(s)
- Amit Agarwal
- Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S D Pandey
- Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhinav Khare
- Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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5
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Amar DN, Rao S, Bilagi R, Hiregoudar RN, Kanakpur S. Disseminated tuberculosis presenting as a tubercular sinus with myositis of forearm in an immunocompetant patient. Indian J Tuberc 2022; 69:699-701. [PMID: 36460411 DOI: 10.1016/j.ijtb.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/04/2021] [Indexed: 06/17/2023]
Abstract
Disseminated tuberculosis is a life-threatening form of tuberculosis resulting from haematogenous spread of M. tuberculosis. It is most commonly seen in an immunocompromised patient. Here we report a case of Pulmonary tuberculosis with Tubercular myositis of forearm flexors and carpal tunnel syndrome presenting as a discharging sinus in an immunocompetent patient.
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Affiliation(s)
- D N Amar
- Department of Surgery, Srinivas Institute of Medical Sciences and Research Institute (SIMS and RC), India
| | - Shobitha Rao
- Department of Respiratory Medicine, SIMS and RC, India.
| | - Rakesh Bilagi
- Department of Respiratory Medicine, SIMS and RC, India
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Yushan M, Yalikun A, Hamiti Y, Lu C, Yusufu A. Clinical features and treatment outcome of wrist tuberculosis in adult- a retrospective study of 84 consecutive cases with minimum of 2 years follow up. BMC Musculoskelet Disord 2022; 23:618. [PMID: 35761223 PMCID: PMC9238136 DOI: 10.1186/s12891-022-05563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Wrist tuberculosis (TB) is a rare disease that may result in residual deformity, pain, or stiffness even after proper antitubercular chemotherapy (ATT) and surgical intervention. The aim of our study is to present clinical features and functional outcomes of wrist TB in a consecutive series of 84 adult patients with a minimum of 2 years of follow-up.
Methods
Clinical features and treatment outcomes of 84 consecutive adult patients with wrist TB from January 2003 to June 2018 including 45 men and 39 women, with a mean age of 46.8 years (18–84) were retrospectively analyzed. Data were collected on participants’ demographic details. The primary outcome measures were QuickDASH score, grip strength, Visual Analogue Scale (VAS), and PRWHE. Secondary outcomes include health-related quality of life was evaluated using the EuroQol five-dimension five-level (EQ-5D-5L), assessment and postoperative complications of patients who underwent operation were also recorded.
Results
All 84 patients with an average follow-up of 50.8 (24–105) months. The mean duration of symptoms before treatment was 10.5 months (2–21). There were 27 patients with bony and 57 with primarily soft-tissue involvement based on preoperative evaluation of plain radiographs and MRI. There were 33 patients treated with ATT and 51 patients were treated with surgery followed by ATT. Among them, 13 patients (15.5%) underwent incision and decompression, 14 patients (16.7%) underwent wrist synovectomy, 13 patients (15.5%) underwent wrist joint fusion by plate fixation, and 11 patients (13.1%) underwent wrist joint fusion by external fixation. At the last clinical visit, the QuickDASH, and PRWHE scores of all patients decreased significantly, the VAS improved from 5.9 to 1.4, EQ-5D-5L utility index improved from 0.36 to 0.88, EQ-VAS improved from 40.2 to 89.1. All patients indicated good wrist recovery at the last follow-up, and the treatment achieved satisfactory clinical outcomes.
Conclusion
The onset of wrist TB is insidious; early diagnosis, good patient compliance, and surgery combined with ATT are crucial steps for treatment of wrist TB, and also essential for the patient's postoperative recovery. Wrist arthrodesis has achieved satisfactory results in the treatment of severe wrist TB.
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7
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Angerett NR, Chen Z, Kromka JJ, Muzio AE, Kahan ME, Ingari JV, Maurer RJ. Rare septic arthritis of the wrist and carpus primary osteoarticular manifestation of Mycobacterium tuberculosis: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221102004. [PMID: 35619746 PMCID: PMC9127846 DOI: 10.1177/2050313x221102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium tuberculosis is one of the oldest and most studied infections, yet it remains one of the most common causes of infection-related death worldwide. The majority concern pulmonary tuberculosis. Therefore, extrapulmonary cases are rare and are often neglected in the differential diagnosis, especially in chronic musculoskeletal complaints. Nevertheless, osteoarticular manifestation of tuberculosis can cause disabling destruction of bone, cartilage, and surrounding soft tissues which may be exacerbated by a delay in diagnosis. This case report documents a case of primary osteoarticular tuberculosis causing septic arthritis of the wrist and carpus. In our case, the patient had no pulmonary burden of tuberculosis, which further delayed diagnosis and lead to irreversible damage to the wrist as well as carpus. This case illustrates the need to consider this diagnosis in at risk populations in order to prevent a delay in diagnosis and treatment.
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Affiliation(s)
- Nathan R Angerett
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Zhongming Chen
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Joseph J Kromka
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anna E Muzio
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
| | - Michael E Kahan
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - John V Ingari
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Robert J Maurer
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
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8
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Lopes-Coutinho L, Rosa J, Santos Silva M, Silva C, Pereira A. Carpal Tunnel Syndrome as the Initial Manifestation of Wrist Bone Tuberculosis: A Case Report. JBJS Case Connect 2020; 10:e2000193. [PMID: 34061476 DOI: 10.2106/jbjs.cc.20.00193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report the case of a patient with bone tuberculosis (TB) of the wrist, whose initial manifestation mimicked the typical clinical presentation of carpal tunnel syndrome. This misdiagnosis lead to surgical mistreatment. After no clinical improvement, thorough study was carried out, and bone TB was diagnosed. Tuberculostatic treatment was performed for 12 months. Wrist arthrodesis was performed after 6 months because of pain and very limited flexion-extension range of motion. CONCLUSION Our case highlights the importance of differential diagnoses in the face of such frequent and suggestive symptoms of carpal tunnel syndrome.
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Affiliation(s)
- Luís Lopes-Coutinho
- 1Resident of the Orthopaedics Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal 2Orthopaedic Surgeon, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
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9
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Tuberculosis Presenting as Isolated Wrist Swelling: A Case Report and Review of Literature. Case Rep Surg 2019; 2019:4916157. [PMID: 31772811 PMCID: PMC6854222 DOI: 10.1155/2019/4916157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background. Tuberculosis is a common disease entity in South East Asian countries with a significant global burden. An extra skeletal manifestation such as monoarticular TB is common, but isolated involvement of the wrist is rare. Case Summary. A 53-year-old Sri Lankan male with long-standing diabetes presented with an isolated hand swelling for a 7-month duration. His initial imaging and MRI showed multiple destructive lesions in the carpal bones, surrounding focal fluid collections and found to have caseous material intraoperatively. His histology and microbiological studies were positive for TB with no other concurrent evidence of TB elsewhere. Conclusion. Different presentations of tuberculosis should be considered when patients are presenting with atypical clinical and initial basic investigation findings in relation to monoarticular pathologies.
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10
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Matta Ramos RF, Cancian L, Calcagnotto F, Zeni R, Varela G, Burgues T, Silva JB. Synovial tuberculosis of the hand: An ancient disease in an unusual localisation. Indian J Plast Surg 2019; 50:130-137. [PMID: 29343887 PMCID: PMC5770925 DOI: 10.4103/ijps.ijps_73_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Tuberculosis is the most prevalent infectious disease in the world. It is mainly caused by Mycobacterium tuberculosis. Osteoarticular tuberculosis represents 1%-3%. Tenosynovitis is the most common form of the disease in the hand. Aims The aim of this study is to present an update of synovial tuberculosis. Materials and Methods The authors present a literature review, the clinical and surgical management and case reports. Results The outcomes were satisfactory and were not report complications. Conclusions Early diagnosis, surgical transection of the transverse carpal ligament, debridement and complete excision of the infected synovium may be required, along with antituberculosis drugs. Knowledge of this disease in the hand can provide a better diagnosis and outcome.
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Affiliation(s)
| | - Lucas Cancian
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Calcagnotto
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo Zeni
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriel Varela
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tamsin Burgues
- General Surgery Department, Santa Casa da Misericordia Hospital, Rio de Janeiro, Brazil
| | - Jefferson Braga Silva
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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11
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Tang X, Gong F, Yu B. Letter to Editor regarding "Comparison between single portal endoscopic and 1-cm open carpal tunnel release": Could the 1-cm open carpal tunnel release surgery miss space-occupying lesions? HAND SURGERY & REHABILITATION 2019; 38:276-277. [PMID: 31077868 DOI: 10.1016/j.hansur.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/31/2022]
Affiliation(s)
- X Tang
- Department of Orthopaedic Surgery, Jiangxi Provincial People's Hospital, 152, Ai Guo Road, Nanchang, 330006, Jiangxi, People's Republic of China
| | - F Gong
- Department of Orthopaedic Surgery, Jiangxi Provincial People's Hospital, 152, Ai Guo Road, Nanchang, 330006, Jiangxi, People's Republic of China
| | - B Yu
- Department of Orthopaedic Surgery, Jiangxi Provincial People's Hospital, 152, Ai Guo Road, Nanchang, 330006, Jiangxi, People's Republic of China.
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12
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Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative? Ann Plast Surg 2017; 77:169-72. [PMID: 26418769 DOI: 10.1097/sap.0000000000000603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery.
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Chammas M, Boretto J, Burmann LM, Ramos RM, dos Santos Neto FC, Silva JB. Síndrome do túnel do carpo – Parte I (anatomia, fisiologia, etiologia e diagnóstico). Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.08.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014; 49:429-36. [PMID: 26229841 PMCID: PMC4487499 DOI: 10.1016/j.rboe.2014.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/28/2013] [Indexed: 12/31/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Electroneuromyographic examination may be recommended before the operation or in cases of occupational illnesses.
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Affiliation(s)
- Michel Chammas
- Hand and Upper-Limb Surgery Service, Peripheral Nerve Surgery, Hospital Lapeyronie, University Hospital Center, Montpellier, France
| | - Jorge Boretto
- Hand Surgery Service, Italian Hospital, Buenos Aires, Argentina
| | - Lauren Marquardt Burmann
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Renato Matta Ramos
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Francisco Carlos Dos Santos Neto
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Jefferson Braga Silva
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
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Nerve compression syndromes of the hand and forearm associated with tumours of non-neural origin and tumour-like lesions. J Plast Reconstr Aesthet Surg 2014; 67:828-36. [DOI: 10.1016/j.bjps.2014.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 12/15/2013] [Accepted: 02/02/2014] [Indexed: 12/16/2022]
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16
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von Glehn F, Damasceno A, Miotto N, Naseri EP, Costallat LTL, França MC, Nucci A, Ramos MC. Carpal tunnel syndrome with paracoccidioidomycosis. Emerg Infect Dis 2013; 18:1390-2. [PMID: 22840753 PMCID: PMC3414040 DOI: 10.3201/eid1808.120153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Probst FA, Koch M, Lohmeyer J, Machens HG, Schantz JT. Tuberculous extensor tenosynovitis of the hand. Arch Orthop Trauma Surg 2012; 132:1141-5. [PMID: 22643800 DOI: 10.1007/s00402-012-1527-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 02/09/2023]
Abstract
Tuberculous tenosynovitis is a rare manifestation of extrapulmonary tuberculosis (Tb), especially if solely the dorsal hand compartment is affected. In this report, we present the medical history of an immuno-competent 32-year-old man presented with a painful swelling of the right dorsal wrist. Initial inflammation onset had occurred 6 months before he consulted our service, resulting in consultation of several physicians and extensive diagnostic procedures without gaining a specific diagnosis. Finally, after extensive diagnostic tests, a tenosynovectomy was performed and tuberculosis-induced extensor tenosynovitis was detected. The diagnosis was established by positive histology, repeated specific PCR and T-SPOT.TB. Tuberculous tenosynovitis can easily be overlooked as a cause of chronic tenosynovitis particularly in immunocompetent young people lacking any risk factors.
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Affiliation(s)
- Florian A Probst
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Lindwurm Str. 2a, 80337, Munich, Germany
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19
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Chen CH, Wu T, Sun JS, Lin WH, Chen CY. Unusual causes of carpal tunnel syndrome: space occupying lesions. J Hand Surg Eur Vol 2012; 37:14-9. [PMID: 21825010 DOI: 10.1177/1753193411414352] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Space occupying lesions found at surgery caused or contributed to carpal tunnel syndrome in 23 of 779 patients operated for carpal tunnel syndrome from January 1999 to December 2008. The mean age of these 23 patients was 52.9 years, and in patients who had a local swelling or palpable mass, ultrasonography or magnetic resonance imaging (MRI) was done. All had open release of the transverse carpal ligament and lesions were removed. Histopathology showed tophaceous gout in 10 men, tenosynovitis in seven patients and tumors in eight. The tumors included ganglion cysts in two, lipoma in three and fibroma of the tendon sheath in one. The neurological symptoms subsided after surgery in all. In patients with gout, one had an infected wound and another had recurrence of symptoms 1 year after later. Carpal tunnel syndrome caused by a space occupying lesion is rare and more complicated than idiopathic carpal tunnel syndrome.
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Affiliation(s)
- C-H Chen
- Department of Orthopedic Surgery, National Taiwan University & Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
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Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Omawi M. Tuberculosis of the hand. J Hand Surg Am 2011; 36:1413-21; quiz 1422. [PMID: 21764526 DOI: 10.1016/j.jhsa.2011.05.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 05/29/2011] [Indexed: 02/02/2023]
Abstract
There has been recent interest in tuberculosis of the hand because of a rising incidence owing to increasing numbers of immigration, an aging population, and immunosuppressed people including affected patients with human immunodeficiency virus. In this article, we review the epidemiology, bacteriology, pathophysiology, diagnosis, and principles of treatment of tuberculosis of the hand. The second part of the report emphasizes the classification of hand tuberculosis (cutaneous lesions, tenosynovitis, bursitis, osteomyelitis, arthritis, and tuberculous hypersensitivity reactions) along with the classic presentations of each of these hand lesions.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia.
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