Prevalence of Tuberculous Tenosynovitis of Hand and Wrist and Clinical Outcome in Sisaket hospital

Abstract

Background: Tuberculous tenosynovitis of hand and wrist is rare infection. Diagnosis is usually difficult in the early stage and often missed. Early diagnosis and effective treatment can achieve an excellent outcome and prevent following complications.
Methods: Data of patients with tuberculous tenosynovitis of hand and wrist from October 2013 to September 2022 were collected from medical records and clinical database of Sisaket medical data center. The data were analyzed by descriptive statistics include frequency, percentage and average.
Results: The prevalence of all in-patient tuberculosis from October 2013 to September 2022 was 5,561 cases, musculoskeletal tuberculosis was 771 cases (13.9%), and tuberculous tenosynovitis of hand and wrist was 58 cases (1.0%). Twenty-nine tuberculous tenosynovitis of hand and wrist were included in this study, 17 male and 12 female. Average age was 60.2 years. Four had history of TB exposure. The wrist was the most commonly involved site (75.9%), mainly on the right (69.0%). Clinical presentations were varied, but painful swelling of wrist, numbness and finger stiffness were the most common presenting features. Six combined with TB lung, which all were sputum AFB negative. Thirteen patients (44.8%) were misdiagnosed or previously treated in other conditions. All patients were operated with tenosynovectomy and followed by anti-tuberculosis drugs for 9-12 months. Hand function and stiffness were evaluated by a modified score of Green and O’Brien. All patients that had the full-course anti-tuberculosis treatment (ATT) were cure and none had recurrence until the end of the study. Eighty-nine percent had good to excellent result in hand function, but the complications can occur in cases that had delayed diagnosis and interrupted anti-tuberculosis drugs. The common complications were wound dehiscence, chronic wound, recurrent mass or pus collection and tendons rupture, that led to a poor outcome.
Summary: The tuberculous tenosynovitis of hand and wrist is rare, but still occasionally encountered, especially in endemic areas as in Sisaket. The patients have a varied presentations and still misdiagnosed, especially by general practitioners. Tenosynovectomy combined with anti-tuberculosis drugs are effective treatment. Early diagnosis and patient cooperation in anti-tuberculosis treatment are the key of successful treatment and excellent outcome.