title: Clinical outcome of the chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterium treated by extensive tenosynovectomy and drugs.
abstract: Chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterial (NTM) infection is uncommon. Although some authors have recommended combining surgical and drug therapy, there are few reports about the timing of drug administration after operation. The purpose of this retrospective study was to analyse the clinical outcome of the protocol, which consisted of extensive tenosynovectomy and drug therapy administered after culture results had been obtained. Four men and one woman were included. Average age was 57.4 years and average follow-up period was 46.7 months. Extensive tenosynovectomy was performed and surgical specimen was examined histopathologically and microbiologically. After a positive culture result had been obtained, three kinds of drugs were administered. Clinical outcome including infectious condition, range of motion, and grip strength was examined. All patients were immunocompetent and had no underlying disease. Three patients were diagnosed at first operation and two were diagnosed at second operation. The average period of drug therapy was 5.5 months. In four patients, infection resolved with combination therapy. In one patient with surgical treatment, only swelling remained. Osteomyelitis of the scaphoid was found in one patient to whom systemic steroid had been administered because of a negative culture result at first operation. For immunocompetent patients, flexor tenosynovitis in the hand caused by NTM was resolved with a combination of surgical and drug treatment. Drug treatment seemed to be essential after a reduction of the infectious lesion and the timing of administration was safe enough to resolve in four patients.
authors.affiliation: Department of Orthopaedic Surgery, Kansai Rosai Hospital , Amagasaki City, Hyogo , Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Minoda
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Horiki
authors.forename: Kakuro
authors.initials: K
authors.lastname: Denno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoneda
authors.forename: Koichi
authors.initials: K
authors.lastname: Tada
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006225:Hand / Q000382:microbiology* / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D007121:Immunocompetence; D007538:Isoniazid / Q000627:therapeutic use; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000628:therapy*; D019909:Mycobacterium kansasii / Q000302:isolation & purification; D019910:Mycobacterium marinum / Q000302:isolation & purification; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D021361:Scaphoid Bone / Q000382:microbiology / Q000601:surgery; D000074402:Synovectomy; D013717:Tenosynovitis / Q000382:microbiology* / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D064704:Levofloxacin; D004977:Ethambutol; D017291:Clarithromycin; D007538:Isoniazid; D012293:Rifampin