Professional Documents
Culture Documents
Presented by: -
Dr.Surendra U Kamath
Dr.Praveen Patil
Dr Harshvardhan
Date: 29/01/2008
In fluid type The bursa becomes distended with clear fluid containing melon-seed
bodies & its lining membrane is thickened & granular.
In dry type The lining membrane becomes replaced by tubercular granulation tissue
which proliferates to encompass & invade the tendons.
Clinical features
Is a hour glass swelling
Gradual onset of swelling with mild aching pain, in the region of the affected
tendon sheaths.
The pain is seldom severe, accompanies with the stiffness of the finger.
Characteristically it affects the lowest five or six centimeters of the front of the
forearm & the proximal part of the palm, sometimes the flexor sheaths of the
fingers & thumb are swollen, giving the digits a fusiform appearance.
In many cases fluctuation can be elicited with some crepitus between the forearm
swelling & the swelling in the palm with the flexor retinaculum in between.
At first range of movements of the fingers & thumb is impaired slightly.
Later there is moderate restriction of flexion & extension of digits, with
corresponding loss of functions.
Diagnosis
Persistent swelling of gradual onset in the line of tendon sheaths in the lower
forearm & hand always suggests chronic tenosynovitis. Fluctuation between
the forearm swelling & the palmar swelling provides strong corroborative
evidence.
Here curvilinear incision, starts in the lower forearm, skirts the thenar crease &
continues distally in the direction of the head of the fourth metacarpal.
If the radial bussa involved, additional midlateral incision is required for the
thumb.
In case of sublimus tendon rupture, it is excised & the stump is restored to the
profundus by transferring the distal stump to the adjacent tendon with intact
motor.
The combination of surgery & antibiotics should eradicate the disease, long term
follow up examination are needed to ensure that other lesions have not
subsequently progressed.
REFERENCES:
1. Outline of Orthopaedics, 7th Ed, John Crawford, Adams.
2. Surgery of hand, J.B.Lippincott, 4th Ed 1964.
3. Baily & Loves Short practice of surgery, 16th edition.
4. The Infected Hand, David & Bailey 1963 1st Ed.
5. Tuberculosis in the wrist and hand, Robert. H.C.Robins.
6. JBJS, Feburary 1957, vol 39B,91-101.
7. Green s Operative Hand Surgery, 4th Ed ,1073-1078, 1661-1669,2022-2025