|Year : 2015 | Volume
| Issue : 3 | Page : 288-290
Tubercular compound palmar ganglion causing carpal tunnel syndrome
Khurshid Ahmad Bhat, Mohammad Hasseb Gani, Omeshwar Singh, Azharu-din Khan
Department of Orthopaedics, Government Medical College Jammu, Jammu, Jammu and Kashmir, India
|Date of Web Publication||2-Sep-2015|
Khurshid Ahmad Bhat
Department of Orthopaedics, Government Medical College Jammu, Jammu, Jammu and Kashmir
Compound palmar ganglion of tubercular origin with carpal tunnel syndrome is an uncommon condition. The aim of this study is to make awareness among practitioners so that the condition can be diagnosed and treated at an early stage before it spreads and destroy the surrounding structures. We present a 50-old-female with a painless swelling of the right wrist and palm of 1-year duration. Furthermore, the patient had a history of paresthesias and numbness of median nerve distribution. Local examination revealed a fluctuating, dumbbell-shaped swelling of the right wrist and palm with numbness of radial three and a half fingers. All the radiographic and laboratory tests were within the normal limits. Patient was treated with thorough debridement and decompression of carpal tunnel along with anti-tubercular therapy. Although rare, tubercular tenosynovitis with carpal tunnel syndrome must be kept in mind as a differential diagnosis of chronic tenosynovitis especially in the developing countries.
العُقد العضبية المركبة درنية المنشأ مع متلازمة النفق الرسغي
تعدّ العقد العصبية المركبة درنية المنشأ مع متلازمة النفق الرسغي حالة نادرة . الهدف من هذه الدراسة رفع الوعي لدى ممارسي مهنة الطب بهذه الحالة لتشخيصها وعلاجها في مراحل مبكرة قبل أن تنتشر وتدمر الأعضاء المحيطة بها. قدمت سيدة تبلغ من العمر 50 عاما بورم غير مؤلم في اليد والكف الأيمن بدأ منذ عام, و قد شكت المريضة من خدر في القصب الأوسط و تفرعاته. أظهر الكشف الموضعي وجود ورم متحرّك بالكف الأيمن وراحة اليد مع خدر في العصب العكبري لثلاث أصابع. جميع الفحوصات المعملية والأشعة كانت معدلاتها في الحدود الطبيعية. عولجت المريضة عن طريق إزالة الأنسجة والضغط من النفق الرسغي ما استخدام العقاقير المضادة للدرن.
Keywords: Carpal tunnel syndrome, compound palmar ganglion, tubercular tenosynovitis
|How to cite this article:|
Bhat KA, Gani MH, Singh O, Khan Ad. Tubercular compound palmar ganglion causing carpal tunnel syndrome. Saudi J Sports Med 2015;15:288-90
|How to cite this URL:|
Bhat KA, Gani MH, Singh O, Khan Ad. Tubercular compound palmar ganglion causing carpal tunnel syndrome. Saudi J Sports Med [serial online] 2015 [cited 2019 Jul 19];15:288-90. Available from: http://www.sjosm.org/text.asp?2015/15/3/288/164318
| Introduction|| |
Chronic tenosynovitis of flexor tendons of the wrist or compound palmar ganglion is due to the tubercular infection of the tenosynovium. It is more common in males involving the dominant hand.  Although rare, it should be kept as a possibility in cases of chronic tenosynovitis in developing countries. Once infected, it can lead to the carpal tunnel syndrome due to the median nerve compression,  however, early surgical debridement can prevent the destruction of the surrounding bones.
| Case Report|| |
A 50-year-old female housewife came to our OPD with chief complaints of a 9 months old painless and fluctuating swelling on the volar aspect of the right wrist and palm [Figure 1]. She also had a history of feeling numbness of radial three and a half fingers of right hand. As such there was no history of pulmonary tuberculosis (TB), any trauma or contact with TB patients. Also, the patient had no constitutional symptoms. On local examination, there was a dumbbell shaped swelling of around 7 cm × 2.5 cm over the volar aspect of the wrist and palm. Skin overlying the swelling was normal, and the cross fluctuation test was positive. There was a numbness of radial three and a half fingers of right hand. Wrist and chest radiographs were normal. Laboratory tests including erythrocyte sedimentation rate were within the normal limits.
Patient was taken for surgical excision through a carpal tunnel incision under regional axillary block [Figure 2]. After releasing the flexor retinaculum, a single encapsulated mass was seen extending from the wrist to mid palm [Figure 3]. Multiple rice bodies or melon seeds were seen after opening the capsule of the swelling [Figure 4]. Thorough debridement, tenosynovectomy and decompression of the carpal tunnel was done. Primary wound closure was done, and compression bandage applied. Patient was followed up at regular intervals and was put on anti-tubercular treatment for 9 months. At 18 weeks patient was symptomless with full ROM. At 1-year follow-up there were no further complaints or recurrences of the disease.
| Discussion|| |
There have been many studies on TB of upper extremity like wrist osteoarthritis, metacarpal/phalangeal TB and tenosynovitis. However, compound palmar ganglion with carpal tunnel syndrome is very rare. Mode of transmission may be direct or hematogenous spread from a primary focus in the body like lungs, gastrointestinal tract, lymph nodes, etc., TB tenosynovitis of wrist flexor tendons commonly involves the dominant hand.  Diagnosis of this disease is often delayed due to its slow progression and minimal symptoms.  Although rice bodies in chronic tenosynovitis is highly suggestive of TB, , these can also be seen in many conditions, like SLE, rheumatoid arthritis, gouty arthritis, pigmented villonodular synovitis of tendon sheath, fungal infection, etc. ,,, TB compound ganglion should be treated with thorough debridement and decompression of carpal tunnel along with the anti-tubercular medications to prevent the complications and recurrences.
| Conclusion|| |
Although rare, TB should be kept in mind while evaluating the compound palmar ganglion especially in developing countries like India. Early diagnosis and proper treatment can prevent the complications and recurrences of the disease.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]