title: Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative?
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.
authors.affiliation: From the *IST-EL Hand Surgery, Microsurgery and Rehabilitation; †Department of Orthopaedics and Traumatology, Şişli Hamidiye Etfal Education and Research Hospital; ‡Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpasa Hospital; §Department of Plastic and Reconstructive Surgery, Kartal Lütfi Kirdar Education and Research Hospital, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Kabakaş
authors.forename: Meriç
authors.initials: M
authors.lastname: Uğurlar
authors.forename: Derya Bayirli
authors.initials: DB
authors.lastname: Turan
authors.forename: Nebil
authors.initials: N
authors.lastname: Yeşiloğlu
authors.forename: Berkan
authors.initials: B
authors.lastname: Mersa
authors.forename: İsmail Bülent
authors.initials: İB
authors.lastname: Özçelik
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D000074402:Synovectomy; D013710:Tendons / Q000601:surgery*; D013717:Tenosynovitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014953:Wrist
chemical_list: D000995:Antitubercular Agents