Wrist Extensor Tenosynovitides: A Case Report

Aidin Arabzadeh; Hosein Hamdilahzadeh; Kian Zohrabi; Mahmoud Farzan; Omid Salkhori

doi:10.18502/jost.v9i1.12569

Aidin Arabzadeh Assistant Professor, Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Hosein Hamdilahzadeh Clinical Fellowship Candidate, Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Kian Zohrabi Clinical Fellowship Candidate, Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mahmoud Farzan Professor, Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Omid Salkhori Resident, Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v9i1.12569

Keywords: Case Reports; Tendinopathy; Wrist

Abstract

Background: Rice bodies can be found in rheumatic diseases, infectious diseases, and osteoarthritic joints. Rice bodies' most common locations include the subacromial bursa of the shoulder and the knee, while rice body synovitis of the wrist extensor tendons is uncommon. We have presented the case of tuberculous tenosynovitis with rice body formation in the extensor tendon sheaths of the hand and wrist.

Case Report: A 51-year-old man presented with swelling and mild pain in the dorsal side of left wrist, hand, and proximal phalanx of the second finger. He stated a history of traumatic injury to the proximal phalanx of the index finger. Radiographs showed a softtissue mass shadow, and magnetic resonance imaging (MRI) showed edema and soft tissue swelling around extensor tendons extending into the distal forearm and ulnar side of the second finger in favor of tenosynovitis. Laboratory test results were normal. The patient had a negative Mantoux test result and no history of mycobacterial exposure. Surgical exploration of the lesion revealed rice bodies in the synovial sheath of extensor tendons in the wrist, extending distally to the dorsal aspect of the hand, especially the radial side. Removal of the rice bodies and complete excision of the sheath and tenosynovectomy was performed.

Conclusion: As in our case, even in the absence of past tuberculosis (TB) infection or exposure, Mycobacterium TB (MTB) should be considered in the differential diagnosis of long-standing extensor tenosynovitis in the hand and wrist.