Tuberculosis of the hand and wrist

Over the past 5 years we have encountered 11 cases of Mycobacterium tuberculosis of the hand and wrist. The most striking feature of this series was the delay between the onset of symptoms and the correct diagnosis. Many patients had a diagnosis of rheumatoid arthritis or nonspecific synovitis prior to the diagnosis of tuberculosis. There was a striking lack of pulmonary symptoms. Only two patients had a prior history of tuberculosis and only one had significant pulmonary involvement. Most had tenosynovitis involving the flexors or extensors. Three had tenosynovitis and arthritis whereas one had only tuberculous arthritis. Two patients had carpal tunnel syndrome as a result of carpal canal involvement. Ten of the 11 patients had apparent cures of tuberculosis subsequent to surgical debridement and antituberculosis therapy.