Suppurative tenosynovitis with chronic carpal tunnel syndrome due to corticosteroid injections: A case report.

INTRODUCTION

Steroid hormone blocking is a common treatment for tenosynovitis. However, local steroid hormone blocking requires careful attention to the local inflammatory response, as infection can cause severe local soft tissue inflammation and damage.

PRESENTATION OF CASE: A 46-year-old female patient received local steroid hormone blocking treatment for tenosynovitis of the right thumb at another hospital 3 months earlier. Five days later, the patient gradually experienced redness, swelling, and pain in her right hand. By day 7, the symptoms worsened with increased swelling, wrist pain, and finger numbness. After the carpal tunnel incision, the patient's symptoms improved upon admission to the local hospital's emergency department. However, 2 weeks post-operation, she experienced recurring numbness, pain, discomfort, and local sinus exudation in her right hand, which worsened over 2 months, prompting the patient to seek outpatient treatment at our hospital.

DISCUSSION: An increase in local content within the wrist joint content is a major cause of carpal tunnel syndrome. Repeated stimulation of the inflamed tissues often leads to the development of granulomatous hyperplasia. Hyperplastic granulomas often produce local compression. If located in the peripheral nerve duct, it may cause nerve entrapment and lead to peripheral nerve injury. Surgery is often required to excise the hyperplastic tissue and release the entrapped nerve.

CONCLUSION

Prompt and thorough debridement is necessary for addressing local soft tissue infections caused by suppurative tenosynovitis. Failure to do so may result in recurrent local granuloma hyperplasia and the development of local compression diseases, especially in wrist median nerve compression cases.