Host: Do you often see a thing called tenosynovitis involving the arm or the wrist?
Guest: Tenosynovitis of the fingers and wrist is quite common, but not as common as trigger fingers. Trigger finger is also tenosynovitis.
Host: Well, first of all what do you mean by tenosynovitis, it is a big word and what does it really mean?
Guest: So teno- stands for tendon; syno- stands for the synovium, the lining of the tendon; and -itis stands for the inflammation.
Host: So where does this come from?
Guest: Tenosynovitis can come from two things; one from idiopathic inflammation and second --
Host: Idiopathic mean the does not know why.
Guest: And the second, from secondary causes like, rheumatoid arthritis and the third one, I should have said three causes, is from infection. And the most common infectious cause of tenosynovitis in the fingers and the wrist and forearm is tuberculosis.
Host: Tuberculosis!
Guest: Tuberculosis in Brooklyn and Bronx is the most common cause of infectious tuberculosis.
Host: I thought TB was almost eradicated, and you are telling me you are seeing TB.
Guest: Yes in several cases of --
Host: Are these people born from the other parts of the world and then came here.
Guest: 60% of the patients who have tuberculosis in our country are immigrants from other countries.
Host: That’s 60%. Now you get 40%. I mean we are seeing in TB in this country too now?
Guest: 40% of the American born people develop tuberculosis, but tuberculosis is not so common now.
Host: Are there some viruses that can cause tenosynovitis, maybe just cause inflammation build up.
Guest: Patients who have HIV; they have a higher incidence of tenosynovitis and majority of them is tuberculosis.
Host: In kids we know it can affect especially the hip joint, and we usually think it is a virus but it goes away by itself, thank god.
Guest: Many times, it goes away by itself, but in the hip you have to be careful, make sure that there is no bacterial infection.
Host: But it is a very --
Guest: It's a disaster.
Host: But your approach, basically, is very conservative of situations like that?
Guest: For tenosynovitis of the wrist and the fingers, the basic treatment is to immobilize the joint and if that doesn't work, give a cortisone injection. And if that doesn't work, then take the biopsy to make sure it is not an infection, and perhaps they will tell you for some infection.
Host: Thank you very much.
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