Compound palmar ganglion associated with tuberculous arthritis of wrist causing compression of the median and ulnar nerves: Management

50 years old male, agricultural labourer, presented with 5 months history of pain and swelling of the right wrist and hand. There was no history of any previous trauma or other constitutional symptoms. Patient had associated numbness of fingers of right hand with reduced hand grip. On clinical examination, a dumb bell shaped swelling was noted on the palmar aspect of wrist and hand with cross fluctuation positive. Blood investigations revealed elevated ESR and CRP. X ray right wrist showed features of early arthritis. Nerve conduction study showed features of entrapment neuropathy of median and ulnar nerve. MRI wrist showed features of tuberculous tenosynovitis of flexor tendons with early arthritis of right wrist. Patient was treated by excision biopsy of the compound palmar ganglion and started on anti-tuberculous drugs after histopathology confirmed tuberculous tenosynovitis. Post operatively the patient improved clinically with reduction in pain and on follow-up numbness and functional activity of right hand improved well.