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Mycobacterium xenopi is an atypical acid-fast bacillus which may colonize tap water supplies. It typically causes pulmonary infection, particularly in patients with pre-existing lung damage, and non-pulmonary involvement is rare. We describe the first reported case of tenosynovitis due to this organism in an immunocompetent male patient.
A 68-year-old man with adult-onset diabetes mellitus suffered an accidental puncture wound to the palm of his hand while playing with his pet dog. He received cephalosporin prophylaxis for 1 week. No inflammation occurred. Six months later, a mass developed near his elbow. It was removed. Histopathology revealed granulomas containing acid-fast bacilli (AFB). No culture was done. Swelling and decreased motion of the wrist and fingers developed. Magnetic resonance imaging revealed inflammation of the flexor compartment of the hand, wrist, and forearm. Surgical incision and drainage yielded purulent material, granulomatous inflammation, with AFB. Cultures yielded Mycobacterium kansasii. Several surgical procedures were required; M kansasii was recovered. He received isoniazid and rifampin for 1 year and prolonged rehabilitation. After 4 years, he was relatively asymptomatic, with good function of wrist and fingers. We believe this to be the first report of tenosynovitis caused by M kansasii in association with a dog bite.
Giant cell tumor of tendon sheath (localized nodular tenosynovitis) remains a disease of unknown origin. Thirty-five giant cell tumors of tendon sheath are reviewed in this study. High recurrence rates can be minimized with attention to accurate preoperative diagnosis and aggressive local excision. The removal of portions of tendon sheath, volar plate, periosteum, or joint capsule may be necessary in selected cases.
Most atypical Mycobacterium infections of the hand are caused by Mycobacterium marinum. We are presenting a rare case of a Mycobacterium chelonei tenosynovitis. The correct diagnosis is important because the chelonei species is resistant to most antituberculosis drugs. Treatment should include surgical debridement and long-term chemotherapy after sensitivities have been determined.
Chronic inflammation of the flexor hallucis longus (FHL) tendon can result in stenosing tenosynovitis. This condition has been well documented in ballet dancers. It usually presents as posteromedial ankle pain, worsened by plantarflexion activities. Although conservative therapy benefits most patients, some recalcitrant cases may require surgical intervention. This is the first case report that describes the occurrence of this condition in a runner with an anomalous flexor hallucis longus muscle.
The scintigraphic pattern of de Quervain's tenosynovitis has not previously been described. Similar three-phase bone scintigraphy patterns were found in four patients with this condition. The characteristic abnormalities consisted of an elongated area of increased uptake in the blood flow and blood pool phases in the anatomical course of the first dorsal compartment of the wrist, together with increased focal uptake of 99Tcm-MDP in the radial styloid on the delayed images. This pattern should be recognized and included in the differential diagnosis of increased uptake of 99Tcm-MDP in the radial compartment of the wrist.
DeQuervain tenosynovitis, which involves the abductor pollicis longus and extensor pollicis brevis tendons, is much more common in women than men and is due to repetitive movements of the hand such as grasping and twisting. Housewives and persons involved in manual occupations using the hands and wrists account for most cases in previous series. In this series, six of 24 female patients (25%) were pregnant or postpartum at the time of onset. In five of the six, activities of infant care aggravated symptoms. Both pregnancy, per se, and mechanical factors appear to play a role in causing this condition.
A thorn puncture to the hand is a common, usually minor childhood injury. A 6-year-old boy developed Alternaria tenosynovitis as a complication of thorn penetration into the digital flexor tendon sheath. He was successfully treated with tenosynovectomy and a prolonged course of itraconazole.
A series of 22 patients with carpal tunnel syndrome secondary to chronic tenosynovitis was divided into two groups. The first group was treated by transverse carpal ligament release alone. The second group was treated by transverse carpal ligament release, external neurolysis of the median nerve, flexor synovectomy, and intraoperative corticosteroid instillation. Both groups were comparable preoperatively as to symptoms, signs, and electrophysiological data. At two years postoperatively there were no statistically significant differences in the symptoms, signs, and electrophysiological data in the two groups. The only difference was that patients undergoing release alone were able to return to work earlier than those patients who had the adjunctive procedures.
Primary amyloidosis is a systemic disease. Amyloid arthropathy is an invalidating and uncommon form of presentation, but tenosynovitis is even rarer as the first sign of the disease. We report herein a case of unilateral amyloid deposit in the synovium of the extensor tendons of the hand, which was the first manifestation of a primary amyloidosis.
Fifteen wrists in 11 patients with rheumatoid tenosynovitis involving the extensor tendons were treated by decompression alone, without synovectomy. The results were not unlike those obtained by the more traditional operation of tenosynovectomy. Alleviation of the retinacular compression appears to have a beneficial local effect to reduce synovitis and to arrest tendon attrition and pain. Removal of the synovium is not required in the treatment of such cases.
A patient had tenosynovitis of the forearm due to Mycobacterium terrae complex. The condition responded well to the combination of surgery and antituberculous chemotherapy.
We report a case of plant thorn injury-induced tenosynovitis of the index finger of the left hand that was cured after surgical removal of the foreign body and partial synovectomy. We review current literature on this infrequently reported topic. Pathologically, thorn synovitis represents a foreign body reaction to retained plant material and is mostly aseptic. The presentation is delayed with the history of preceding injury often forgotten, and the diagnosis thus relies on careful elicitation of history. Imaging may be helpful to localize the plant material when the history is not clear. When possible, removal of the foreign material leads to complete remission, although some patients need partial or total synovectomy.
The presented case is a 36-year-old woman with a history of systemic lupus erythematosus for 10 years. She had progressively painful swelling of the right index finger that later proved to be a rare case of tenosynovitis caused by Mycobacterium avium complex. Serial images of 3-phase bone scans, gallium scan, and magnetic resonance imaging demonstrate the area of involvement.
A case of acute flexor tenosynovitis caused by Streptococcus pneumoniae in a previously well male truck driver is described. The importance of specimen collection and processing in establishing a microbiological diagnosis is emphasized. Early surgical drainage and treatment with penicillin resulted in rapid resolution of the infection and a return to full function of the hand.
This report describes two dogs with bilateral bicipital tenosynovitis which were managed using double tenodesis. Surgical repair involved the attachment of the tendon to the humerus with a bone screw and plastic spiked washer, and a double Bunnell-Meyer suture. Six months postoperatively, neither of the treated dogs displayed any lameness on clinical examination.
An adenovirus was isolated from the tendon fluid of broilers and meat breeders with clinical tenosynovitis. The viral infection was in many cases accompanied by a staphylococcal infection. The significance of the adenovirus is not yet known, although initial transmission studies indicate that it may play a role in the tendon thickening process.
Septic tenosynovitis was diagnosed in seven cattle on the basis of history, physical examination, radiographs, cytological examination of tendon sheath fluids, and microbial culture. A commercially available indwelling multifenestrated silicone rubber drain was used to perform frequent lavage of the flexor tendon sheaths. The sepsis resolved in all cattle. Five of six cattle for which long-term (> 1 year) follow-up information was available were clinically sound on the affected limb and had remained productive members of the herd.