Presentation
Right wrist and hand painful swelling for the last few weeks
Patient Data
There are synovial hypertrophy and effusion involving all flexure tendons sheath at the wrist and the mid palm level. There is an extension of synovial hypertrophy and effusion in the thumb and little flexure tendons up to distal phalanges. Flexure tendon sheaths of the index, middle and ring fingers show no effusion/ synovial hypertrophy. All flexure tendons are intact. There is synovial hypertrophy involving the wrist joint. However, there is no bone erosion.
The pre-surgery photo shows bulging synovitis along the palmar side of the wrist. The second photo shows post synovectomy status. The third photo shows pathology specimen.
Case Discussion
An elderly female presented with the right wrist and hand swelling with pain. Ultrasound findings favored radial and ulnar bursitis along with wrist synovitis. Surgical exploration was done and synovectomy was performed. Histopathology revealed tuberculosis.
Ulnar and radial bursae begin proximal to the carpal tunnel and ends in the mid palm region. The smaller radial bursa communicates flexure pollicis longus tendon sheath. The larger ulnar bursa commonly communicates along with the 5th finger flexure tendons sheath. The ulnar and radial bursae commonly communicate with each other.
Intraoperative photos courtesy: Operating surgeon Dr. Ritesh Patel.
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