Rare Case of Tubercular Tenosynovitis of Wrist Extensor Digitorum Tendons: Case Report

Background: Tuberculosis of musculoskeletal system is rare. Even rare is the involvement of tendon sheaths. Here is the extensor digitorum tendons of wrist joint. Case presentation: 14 yr old female came with swelling at dorsum of wrist and distal forearm since six months. In history there was loss of appatite, loss of weight and evening rise of temperature present. On examination there is soft cystic horizontally mobile ,flactuant swelling with no transillumination. On ultrasonogram, there were multiloculated cystic collections surrounding the extensor digitorum tendons. On MRI also synovial collection noted along the EDC tendon upto elbow level. Lab parameters showed increased ESR and mantoux test was positive. With the provisional diagnosis of tenosynovitis, aspiration by z technique was done and sent for analysis. ADA level is abnormally high confirmed the diagnosis and acid fast bacilli stain was negative for aspirated fluid. Child was started anti-tubercular drugs along with intralesional streptomycine injection .Responded well in 2months with decreased lab parameters and resolvining of swelling and there was no recurrence of swelling at 1year follow up. Conclusion: Typical constitutional symptoms of tuberculosis with non invasive tests like aspirated fluid analysis and MRI findings diagnose Tubercular Tenosynovitis. Antitubercular drugs along with intralesional therapy by streptomycine injection will cure the disease and prevents recurrence. Not every case of disease requires surgical debridment or synovectomys in these days there by preventing ugly scars in young girls.