Abstract
It is a common algorithm for hand surgeons to diagnose and treat persistent post-traumatic wrist pain as complex regional pain syndrome (CRPS). Although it works for many patients, some conditions that affect the wrist don’t fall in this category and worsen with this treatment practice. We present a single-handed patient who had had a non-displaced distal radius fracture and was treated as CRPS for the next three months. He was eventually diagnosed with late tuberculous tenosynovitis of the wrist and a total wrist arthrodesis was performed. We believe that Mycobacterium tuberculosis infection should be in the differential diagnosis of persistent post-traumatic joint pain. This is especially important as Mycobacterium infections are becoming more common due to an increase in patients with chronic immunosuppression and definitive diagnosis and treatment of tuberculous tenosynovitis needs a high index of clinical suspicion.
Résumé
Les chirurgiens de la main ont l’habitude de traiter les douleurs post-traumatiques persistantes selon l’algorithme défini pour ce CRPS (Complex Regional Pain Syndrome). Bien que ce protocole fonctionne pour beaucoup de patients, certaines affections du poignet ne rentrent pas dans cette catégorie et font échouer la thérapeutique. Nous présentons le cas d’un patient n’ayant qu’une main fonctionnelle, qui à la suite d’une fracture non déplacée de l’extrémité distale du radius avait été traité pendant les trois mois suivants le traumatisme avec le protocole CRPS. Une suspicion de synovite tuberculeuse tardive du poignet fut évoquée et une arthrodèse complète du poignet fut réalisée. Nous pensons qu’une infection à Mycobacterium tuberculosis peut faire partie du diagnostic différentiel d’un syndrome douloureux persistant du poignet. Ceci est particulièrement à connaître en raison de l’augmentation des patients à syndrome immuno-déprimé chronique et parce que le diagnostic et le traitement de la ténosynovite tuberculeuse exigent un important faisceau de signes cliniques.
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Gundes, H., Tosun, B., Gundes, S. et al. Persistent posttraumatic wrist pain: complex regional pain syndrome? Mycobacterium tuberculosis infection should be in the differential diagnosis. Eur J Orthop Surg Traumatol 17, 193–197 (2007). https://doi.org/10.1007/s00590-006-0142-8
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DOI: https://doi.org/10.1007/s00590-006-0142-8