primary tuberculosis of hand soft tissue

the musculoskeletal extrapulmonary tuberculosis is uncommon, the upper extremity tuberculosis is not common and the mycobacterial involvement of skin of hands and synovial sheath of tendons is rare. this prospective observational study was undertaken between august  2014 and december 2015 in a tertiary referral hospital. patients attending with suspected primary tuberculosis of soft tissue of the hand were included. anteroposterior and lateral radiographs of the hand, wrist and lung and mri were undertaken. a diagnosis of tuberculosis was made based on histology, and positive culture for mycobacterium. split thickness skin grafting was done after excision of tubercular cutaneous ulcers of hand. postoperatively patients were treated with home based anti-tubercular chemotherapy. lesions of synovial sheath of tendons were excised. splints or plaster slabs were used in all patients. there were 3 males and 2 females with a mean age of 44.75±6.61 years (19-48 years). based on clinical suspicion, plain radiographs and mri, there were 3 patients with involvement of synovial sheath of tendons and 2 patients with involvement of skin of hand. tuberculosis was confirmed histologically and mycobacterium bovis was confirmed microbiologically. the delayed diagnosis is often due to slow progression and numerous differential diagnoses, which often leads to complications. early radical excision of the infected tissues combined with anti- tubercular multidrug therapy gives good functional results and prevents recurrence.