Pathak Pradeep Kumar, Sinha Priti Ranjan, Agrawal Pranjal, Gupta Nikhil, Jain Siddharth
Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India.
J Orthop Case Rep. 2025 Jul;15(7):211-215. doi: 10.13107/jocr.2025.v15.i07.5828.
Chronic volar wrist swelling is a diagnostic challenge, particularly in tuberculosis-endemic regions, where both infectious and inflammatory causes must be considered. Rheumatoid tenosynovitis, an extra-articular manifestation of rheumatoid arthritis (RA), can mimic infectious tenosynovitis, especially in seronegative patients.
We report a case of a 44-year-old male presenting with progressive pain and swelling over the volar aspect of the right wrist for 2 months. Clinical findings of a local rise in temperature, tenderness, and limitation of range of motion suggested flexor tendon tenosynovitis, with differential diagnoses including abscess, tuberculous tenosynovitis, Giant cell tumours, or inflammatory arthritis. Ultrasound and magnetic resonance imaging revealed tendon sheath thickening and features of median nerve compression. The patient had elevated inflammatory markers, but rheumatoid factor and anti-cyclic citrullinated peptide were negative. Excision biopsy and synovectomy with median nerve decompression were performed. Surgical exploration revealed hypertrophied synovium around the flexor tendons. Histopathology confirmed a rheumatoid nodule, establishing the diagnosis of rheumatoid tenosynovitis despite negative serology. The patient's recovery was uneventful postoperatively.
This case highlights the importance of considering rheumatoid tenosynovitis in the differential diagnosis of chronic wrist swelling, even in seronegative individuals. In ambiguous cases, surgical intervention not only alleviates symptoms but also allows for definitive diagnosis through histopathology. A multidisciplinary and vigilant approach is crucial to prevent misdiagnosis and preserve hand function in such presentations.
慢性手掌侧腕部肿胀是一个诊断难题，尤其是在结核病流行地区，必须考虑感染性和炎症性病因。类风湿性腱鞘炎是类风湿关节炎（RA）的一种关节外表现，可模仿感染性腱鞘炎，特别是在血清阴性患者中。
我们报告一例44岁男性，右腕掌侧渐进性疼痛和肿胀2个月。局部温度升高、压痛和活动范围受限的临床发现提示屈肌腱腱鞘炎，鉴别诊断包括脓肿、结核性腱鞘炎、巨细胞瘤或炎性关节炎。超声和磁共振成像显示腱鞘增厚和正中神经受压特征。患者炎症标志物升高，但类风湿因子和抗环瓜氨酸肽均为阴性。进行了切除活检和滑膜切除术并进行正中神经减压。手术探查发现屈肌腱周围滑膜肥厚。组织病理学证实为类风湿结节，尽管血清学阴性，但仍确诊为类风湿性腱鞘炎。患者术后恢复顺利。
本病例强调了在慢性腕部肿胀的鉴别诊断中考虑类风湿性腱鞘炎的重要性，即使是血清阴性个体。在不明确的病例中，手术干预不仅能缓解症状，还能通过组织病理学进行明确诊断。多学科和警惕的方法对于防止此类表现的误诊和保留手部功能至关重要。
