Clinical Misdiagnosis Analysis of Tuberculosis of Tendon Sheath in the Wrist and Hand

WANG Li; YANG Shanhui; HUO Yongxin; QU Long; SUN Fuzhai; WU Xueqiang; SUN Rutao

doi:10.3969/j.issn.1002-3429.2024.21.002

Abstract：Objective To explore the causes of clinical misdiagnosis and preventive measures of tuberculosis of ten-don sheath in the wrist and hand.Methods The clinical data of 3 patients with tuberculosis of tendon sheath in the wrist and hand who had been misdiagnosed from April 2023 to April 2024 were retrospectively analyzed.Results One patient had swollen wrist and sore thumb.According to relevant examination results and postoperative pathological examination,synovitis of the wrist and osteomyelitis of the thumb were considered,and tuberculosis was not excluded.The patient was re-admitted to hospital due to swelling and aggravating pain in the wrist,and tuberculosis was considered.The disease was controlled after anti-tuberculosis treatment,and the patient was diagnosed with tuberculosis of tendon sheath in the right wrist and hand.Mis-diagnosis lasted 3 months.After disease control with anti-tuberculosis treatment,flap operation was performed in another hos-pital.No recurrence of tuberculosis was observed during follow-up,and the wrist joint function and flexion function were limit-ed.A case of left thumb volar mass with increased tenderness and limited movement was considered to have fingertip abscess;however,fingertip abscess recurred after treatment with incision and drainage.Combined with the medical history and physical examination after admission,chronic infection was considered and debridement and drainage were performed;the postoperative pathology confirmed the diagnosis of tuberculosis of tendon sheath in the wrist.The misdiagnosis lasted 11 months.After diag-nosis,the lesion was removed,and no recurrence of tuberculosis was found during follow-up.In addition,the flexion function of the left thumb was satisfactory.One patient with left middle finger proximal ganglion volar mass,which was considered as stenosing tenosynovitis in another hospital,was treated by local injection of Compound Betamethasone injection,but the effect was not good.Combined with physical examination after admission and relevant examination results,tuberculosis infection was considered and lesion clearance was performed;pathological diagnosis was confirmed as proliferative tuberculosis of synovial sheath of tendon in the wrist.The misdiagnosis lasted 14 months.Debridement was performed after diagnosis.No recurrence of tuberculosis was observed during follow-up,and the flexion function of the left middle finger was satisfactory.Conclusion The misdiagnosis rate of tuberculosis of tendon sheath in the wrist and hand is high due to its atypical clinical features and lack of specific diagnostic indicators in the early stage.For the lesions in the wrist and hand that have not responded to long-term symptomatic treatment,it is necessary to be alert to tuberculosis of tendon sheath,and perform lesion clearance and pathologi-cal examination as soon as possible to reduce misdiagnosis.