Bone and joint infections: tuberculous flexor tenosynovitis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Bone and joint infections: tuberculous flexor tenosynovitis

Sample item

A 38-year-old farmer has had a painless swelling across the volar wrist and palm for eight months. Fluctuation can be elicited between the palm and the forearm components, and soft crepitus is felt. Aspiration yields many smooth, white, melon-seed-like bodies. What is the likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Tuberculous flexor tenosynovitis (compound palmar ganglion)

A chronic, painless swelling that bulges above and below the flexor retinaculum, with cross-fluctuation and rice bodies, is tuberculous tenosynovitis of the flexor sheaths, classically called compound palmar ganglion. Treatment is antituberculous therapy with excision of the diseased sheath.

Option by option

  • A. Volar ganglion arising from the radiocarpal joint

    A volar ganglion is a localised cystic swelling and does not give rice bodies.

  • B. Pyogenic flexor sheath infection with Kanavel signs

    Pyogenic flexor sheath infection is acute, with fever, a finger held flexed and pain on passive extension.

  • C. Tophaceous gout of the flexor tendons

    Gouty tenosynovitis gives painful tophi with urate crystals, not melon-seed bodies.

  • D. Tuberculous flexor tenosynovitis (compound palmar ganglion) (correct)

    Correct. Cross-fluctuation across the retinaculum with rice bodies is the classic picture of tuberculous tenosynovitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Tuberculous flexor tenosynovitis (compound palmar ganglion). A chronic, painless swelling that bulges above and below the flexor retinaculum, with cross-fluctuation and rice bodies, is tuberculous tenosynovitis of the flexor sheaths, classically called compound palmar ganglion.

Why is "Volar ganglion arising from the radiocarpal joint" not the answer?

A volar ganglion is a localised cystic swelling and does not give rice bodies.

Why is "Pyogenic flexor sheath infection with Kanavel signs" not the answer?

Pyogenic flexor sheath infection is acute, with fever, a finger held flexed and pain on passive extension.

Why is "Tophaceous gout of the flexor tendons" not the answer?

Gouty tenosynovitis gives painful tophi with urate crystals, not melon-seed bodies.

What concept does this question test?

It tests Bone and joint infections: tuberculous flexor tenosynovitis in Orthopaedics. Treatment is antituberculous therapy with excision of the diseased sheath.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Bone and joint infections: tuberculous flexor tenosynovitis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.