Ann Rehabil Med.  2013 Aug;37(4):572-576. 10.5535/arm.2013.37.4.572.

Tuberculous Tenosynovitis and Ulnar Bursitis of the Wrist

• Lee SM
• Lee WJ
• Song AR

• KMID: 2266615
• DOI: http://doi.org/10.5535/arm.2013.37.4.572

Abstract

Tuberculous infection of the hand is a rare form of extrapulmonary tuberculosis that, left untreated, can cause serious joint and tendon damage. We report the case of a 65-year-old male patient who presented with an insidious flexor weakness of the fifth finger but without any history of trauma. Magnetic resonance imaging revealed a partial tear of the fifth finger flexor tendon with a fluid collection in the tendon sheath and in the flexor compartment along the ulnar side. Under ultrasound guidance, this fluid collection was aspirated and analyzed for Mycobacterium tuberculosis using polymerase chain reaction. The assay was positive for the microorganism, confirming the diagnosis of tuberculous tenosynovitis and ulnar bursitis of the wrist. The early suspicion and diagnosis of this extrapulmonary disease facilitated anti-tuberculous chemotherapy and helped avoid a hasty injection of corticosteroid.

Keyword

Tenosynovitis; Tuberculosis; Polymerase chain reaction

MeSH Terms

Bursitis
Fingers
Hand
Humans
Joints
Magnetic Resonance Imaging
Male
Mycobacterium tuberculosis
Polymerase Chain Reaction
Tendons
Tenosynovitis
Tuberculosis
Wrist

Figure

• 

  Fig. 1 Photographs of the patient demonstrating weak flexion (A) and adduction (B) of the right fifth finger. In the hand radiograph (C), no abnormal findings in bone, joint, and soft tissue are identified.

• 

  Fig. 2 On fat-suppressed T2-weighted image of the right hand, the coronal view (A) shows a partial tear of the fifth finger flexor tendon (arrow), a fluid collection in the tendon sheath (open arrow), contiguous with the flexor compartment along the ulnar side (arrowheads). The axial views were obtained at the levels of the proximal phalanx (B), mid-palm (C) and proximal palm (D-1). The contrast-enhanced T1-weighted axial image of the proximal palm (D-2) shows a thickened synovium of the ulnar bursa (open arrowheads).

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  Fig. 3 Ultrasound-guided fluid aspiration (A) was conducted using an 18-gauge needle (arrowheads) at the point of the ulnar bursa between the fifth flexor digitorum (star) and the palmar interosseous muscle (asterisk). Nested polymerase chain reaction analysis (B) of the fluid revealed the presence of Mycobacterium tuberculosis. M, DNA molecular weight marker; P, positive control; N, negative control; Lane 1, patient sample.

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