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Case Report
 
Compound palmar ganglion: A tubercular manifestation of flexor tenosynovitis of the wrist
K Arun Kumar1, B Kanthimathi2, CS Krishnamurthy3, S Sujai4
1Post Graduate, Division of Orthopaedics, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnadu, India.
2Professor of Orthopaedics, Division of Orthopaedics, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnadu, India.
3Professor of Orthopaedics, Division of Orthopaedics, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnadu, India.
4Post Graduate, Division of Orthopaedics, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnadu, India.

doi:10.5348/ijcri-2012-02-93-CR-7

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How to cite this article:
Arun Kumar K, Kanthimathi B, Krishnamurthy CS, Sujai S. Compound palmar ganglion: A tubercular manifestation of flexor tenosynovitis of the wrist. International Journal of Case Reports and Images 2012;3(2):28-31.


Abstract
Introduction: Compound palmar ganglion of tuberculous origin is uncommon. The clinical picture is very typical and is always confirmed by histopathology. The condition is best managed in its early stages before it spreads to the underlying bones causing destruction.
Case Report: Here, we report a 55-year-old male who presented with pain and progressive swelling over the left wrist and hand. Examination revealed positive cross fluctuation, restriction of movements and islands of numbness over median nerve territory. He was diagnosed to have chronic flexor tenosynovitis of left wrist and was treated with debulking tenosynovectomy along with anti tubercular therapy. He responded to treatment achieving full functional recovery.
Conclusion: Compound palmar ganglion is considered a severe form of extra-pulmonary musculoskeletal tuberculosis. Intra-operative finding of melon seed bodies or rice bodies as seen in our case is pathognomonic of tuberculous tenosynovitis. According to literature, extensive debridement and full course chemotherapy brings about a better prognosis. Early diagnosis, complete debulking and appropriate anti-tubercular therapy is the recommended treatment. It can improve the patient functionally by preventing a subsequent arthrodesis which is a major concern for both the surgeon and the patient.

Key Words: Compound palmar ganglion, Chronic flexor tenosynovitis, Melon seed bodies

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Author Contributions:
K Arun Kumar - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
B Kanthimathi - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
CS Krishnamurthy - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
S Sujai - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
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Conflict of interest:
Authors declare no conflict of interest.
Copyright:
© K Arun Kumar et al. 2012; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see http://www.ijcasereportsandimages.com/copyright-policy.php for more information.)