Clin Orthop 1963; 30: 188–93. However, this presentation is non-specific and mimics many common causes of arthritic diseases. It’s common to get pricked by a thorn while working in the garden, plucking flowers, fruits or vegetables. At this point, a high-resolution ultrasound was ordered requesting a musculoskeletal radiology team, which revealed 5 small (1-2 mm) foreign bodies in the subcutaneous tissue. This caused recurrent pain and swelling of the elbow over a 3-month period. J Orthop Case Rep. 2016 Jul-Aug;6(3):13-15. doi: 10.13107/jocr.2250-0685.478. Clinical presentation of cases may simulate juvenile rheumatoid arthritis with monoarticular involvement and septic arthritis. 4. The success in visualization may be attributed to a number of factors, such as prior to imaging the suspicion of a potential small foreign body was known and communicated to the radiologist, the radiologist and sonographer were specialized in the musculoskeletal system, and the ultrasound used was a high-definition ultrasound. Cahill N, King JD. Seven cases of PTS were identified at our institution from January 1979 to July 1990, six of whom were men. Infectious causes such as septic arthritis and cellulitis were the most common initial diagnoses.10-12 In the diagnosis of a plant thorn as a foreign body, X-ray imaging was found to be ineffective in visualizing thorn fragments, while some cases reported visualization of fragments with ultrasound imaging (Table 3).10-15, Each reviewed case report of plant thorn synovitis ultimately underwent treatment with surgical exploration, removal of foreign material, and synovectomy if the synovium was shown to be compromised. When they are promptly identified and treated, a good result can be expected without further complications. Palm thorn injury to tendons and joints is characterized in most patients by an acute inflammatory stage followed by a relatively asymptomatic period and finally by chronic synovitis or tenosynovitis. There is a condition called plant thorn synovitis: causing redness, swelling, pain and loss of range of movement. 1990 Mar;21(2):97-100. The email address and/or password entered does not match our records, please check and try again. We reported a case of acute monoarthritis over the third metacarpo–phalangeal joint of the right hand after an injury by the thorn of the Zanthoxylum ailanthoides. Radiology 1953; 60: 592–5. Our case of plant thorn synovitis is discussed along with a review of the current literature on plant thorn synovitis in the hands. Palm thorn injury to tendons and joints is characterized in most patients by an acute inflammatory stage followed by a relatively asymptomatic period and finally by chronic synovitis or tenosynovitis. The clinical presentation was that of an acute synovitis of 2 months' duration, that improved quickly after arthroscopy for biopsy, and articular washout. Palm thorn injuries to the hand are frequent lesions in our area. A 48-year-old woman, with a history of methotrexate-controlled psoriasis, was referred to plastic surgery clinic for concerns of retained foreign body near the proximal interphalangeal (PIP) joint of the left long finger. Informed consent was obtained from all patients for being included in the study. 2007 May;26(5):849-51. doi: 10.1007/s10067-006-0482-0. Inasmuch as the palm thorn will be found in only a single joint, diseases which affect multiple joints, such as rheumatoid arthritis, bacteremia, allergic arthritis and Clutton's joints, are easily excluded. New Emirates Medical Journal Journal Country: … This site uses cookies. Blackthorn inflammation. 3 Kelly JJ. With the exception of 2, all patients were reported to have no significant past medical history. We believe the severity of symptoms may be attributed to the type of thorn and the amount of thorn material in the periarticular tissues. Sharing links are not available for this article. 2 Karshner AG, Hanafee W. Palm thorns as a cause of joint effusion in children. Plant-thorn synovitis is a rare cause of arthritis from a plant thorn penetrating a joint. Epub 2008 Sep 5. But they can present as a serious problem in cases of late diagnosis and/or late treatment. J Pediatr Orthop1984;4:175–9. And wear eye protection! Lean Library can solve it. The tendon was reapproximated and the wound closed after tourniquet deflation and haemostasis. Br J Radiol 44:642-645, 1971 6. Clinical presentation of cases may simulate juvenile rheumatoid arthritis with monoarticular involvement and septic arthritis. Arthritis Rheum1977;20:1125–8. Date Palm Synovitis Joint inflammation associated with intra-articular retention of a date palm thorn. Nine weeks postinjury from plant thorn puncture injury. Table 2. Table 1 outlines the demographics from the included case reports. J Pediatr Orthop. You can be signed in via any or all of the methods shown below at the same time. Ages of patients with published reports of plant thorn synovitis involving the hands ranged from 7 to 58 years, with a median age of 24.5 years. This retrospective study compares the results of extensive versus limited synovectomy at the time of palm thorn removal from a joint space. When they are promptly identified and treated, a good result can be expected without further complications. The immunological tests and cultures were negative. What plants cause plant thorn arthritis? An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. Additional informed consent was obtained from all patients for which identifying information is included in this article. No complications were noted. 5 Flatauer FE, Khan MA. We have reviewed seven cases of synovitis caused by date palm thorns, six involving the knee and one the ankle. This penetration causes inflammation of the synovial membrane. A branch with a 10 inch thorn fell down unexpectedly and the thorn pierced my right middle finger. Br J Radiol 1971; 44: 642–5. Pathologic examination of the synovium revealed subacute inflammation with abscess formation and proliferative changes with focal foreign body giant cell reaction. [Google Scholar] Cracchiolo A, 3rd, Goldberg L. Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn. Once the inflammatory process has begun, detection and localization of the thorn can be very difficult. We reported a case of acute monoarthritis over the third metacarpo–phalangeal joint of the right hand after an injury by the thorn of the Zanthoxylum ailanthoides. Chronic synovitis caused by a date palm thorn: an unusual clinical picture . Cracchiolo A, 3rd, Goldberg L. Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn. Blackthorn synovitis 343 Figure 3. As in this case, thorn prick injury, which is particularly caused by thin palm thorns, is frequently missed in clinical history. Case reports: The first patient was a 41-year-old-woman who presented with recurrent arthritis of the right knee after needle fish injury. Tendon sheath inflammation is typically the result of injury to the tendon or surrounding muscle or bone. Plant-thorn synovitis is an uncommon cause of arthritis and has not been reported in Asian countries. 1994 Dec;33(12):1190-1. Consultation of radiographic and sonographic images of the hand post thorn extraction revealed no foreign bodies. Five weeks postinjury, the patient was seen with persistent inflammation and pain of her left long finger PIP joint (Figure 1). These plants include palm trees, roses, black-thorn shrubs, cacti, bougainvillea, yucca, pyracantha, plum trees, and … The time of initial symptom presentation ranged from 24 hours to 4 months after the injury (Table 3). In conclusion, due to its rare occurrence, in combination with diagnostic challenges, plant thorn synovitis is often excluded in the differential diagnosis of arthritic disease. Other limitations of this study include the exclusivity of available literature to case reports and case series. Plant thorn synovitis diagnosed by magnetic resonance imaging. J Pediatr Orthop. I was pricked by a thorn from a sago palm in Lowe’s. Palm thorn synovitis. X-ray of the left hand on postoperative day 10 of synovectomy revealing decreased joint space. For more information view the SAGE Journals Article Sharing page. 1977 Jul-Aug; 20 (6):1206–1212. J Rheumatol 4:567-569,1980 5. Radiology. Better not ignore a thorn prick. Initial radiography and sonography imaging following the removal revealed no foreign bodies. Please read and accept the terms and conditions and check the box to generate a sharing link. Five weeks postinjury from plant thorn puncture to the left hand. Misdiagnosis, Palm thorn, Synovectomy, limited and extensive, Synovitis. J Bone Joint Surg1966;48-B:474–7. Synovitis is a common condition meaning inflammation of the synovial lining of a joint or tendon sheath (the tunnel the tendon runs through). Figure 4. An exploratory surgery was carried out, which revealed multiple plant thorn fragments within the synovium, each measuring approximately 1 mm in size. Clin Rheumatol. Both males and females were reported in the included cases. Due to the unfamiliarity with the diagnosis of plant thorn arthritis and the relatively superficial location of the foreign material, it was anticipated that the tiny foreign bodies would likely resolve spontaneously. We report a 57-year-old healthy … The problem usually arises from the radiolucent non-metallic FBs. After arthrotomy, the joint was thoroughly irrigated with an angiocatheter. 4. 1,2 However, the mechanism by which retained plant thorn material triggers this inflammatory response remains unclear. This site needs JavaScript to work properly. (a) T1w sequen ce show s a low-sig nal, smoo th, w ell-cir cum scr ibed subc u tane ou s les ion sup erf icia l to the. Kchir MM, et al. If you are working around these, be careful. Histopathology demonstrated a granulomatous synovitis. However, the patient’s symptoms were worsening and refractory to anti-inflammatory and antibiotic treatment. Following the injury, the patient had presented to a community hospital emergency department, where large thorn splinters were removed from the skin. Even with these advantages, surgical exploration revealed 5 additional fragments not visualized on imaging. Palm thorn synovitis. This is a case of plant thorn synovitis of the hand in an adult following a plum tree thorn injury, the first reported case in the hands in the past decade. Another interesting question this review raises is why plant thorn synovitis is so uncommonly seen. Radiology. The patient developed cellulitis following the removal and had been taking cephalexin orally for 2 weeks at the time of her consultation. Download Citation | Chronic synovitis caused by a date palm thorn | Synovitis related to plant thorns is a rare pathology. Figure 6. A literature review was conducted by searching key terms: plant, thorn, arthritis, synovitis, hand, and foreign body in MEDLINE, EMBASE, and PubMED databases from 1975 to 2017. J Pediatr Orthop. palm thorn, 2 X 1 mm, were found in the synovium sur- rounded by marked synovial reaction. As such, future studies are necessary to assess risk factors for individuals who go on to develop plant thorn synovitis. RESULTS Inallseven cases theWBC andESR were within normal limits, and noorganism was grown from any joint aspirate. This is reflected by the multiple cases where patients were initially misdiagnosed with conditions like septic arthritis.10 This may especially be the case if the patient does not recall the initial thorn injury. No discernable pattern of injury in the hand was noted, with equal distribution of interphalangeal joints and wrist joint injuries (Table 2). Patients treated by primary extensive synovectomy obtained complete relief of symptoms; patients who underwent … A magnetic resonance imaging examination was initially requested to exclude septic arthritis, and demonstrated a joint effusion, synovitis, and a 2-cm linear opacity embedded in the synovium. 2007 Jun;15(6):758-60. doi: 10.1007/s00167-006-0197-4. Because of this, patients with undiagnosed plant thorn synovitis can progress to develop chronic arthritis.5,16 The annual incidence of undifferentiated arthritis has been shown to range from 41 to 149 per 100 000 adults, comprising approximately 30% of all inflammatory arthritis.18 As high as 50% of these chronic undifferentiated arthropathies do not achieve resolution in symptoms or diagnosis.19 With these numbers in mind, it is important to consider that a subset of undifferentiated chronic arthropathies may be attributable to plant thorn arthritis. 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