Interestingly, including our patient, 2 (25%) of 8 reported cases of plant thorn arthritis in the hands involved a patient with a history of psoriasis. A boy with an inflammatory monoarthritis due to penetration of the joint by palm thorn is presented. The patient began hand therapy to range the affected finger at 4 weeks postoperatively. With the exception of one patient who developed rheumatoid arthritis, all included cases reported a full recovery in the affected joint (Table 3).10-15 Pathology investigation revealed synovium that was described as thickened, granulated, or lobulated from chronic irritation due to the foreign body.11,12,14 All synovium was shown to be sterile with the exception of the case reported by Olenginski et al, which grew Enterobacter agglomerans. As in this case, thorn prick injury, which is particularly caused by thin palm thorns, is frequently missed in clinical history. Epub 2006 Sep 12. Foreign bodies (FB) of the knee come in different forms. We reviewed four cases of tumor like lesion: two cases were around the elbows and two cases at the foot, which developed following injuries caused by palm oil thorns. 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. This retrospective clinical study compares the results of extensive versus limited synovectomy at the time of palm thorn removal from a joint space. 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. For the purpose of surgical planning, a repeat ultrasound was taken and skin markings were made overlying the visualized foreign bodies by radiology (Figure 2). Clipboard, Search History, and several other advanced features are temporarily unavailable. Lean Library can solve it. Presentation is typically delayed, with one case reporting a median of 68.5 days between the time of the injury and the onset of joint pain.2 There is no ideal diagnostic tool, and although ultrasound has been reported to be effective in visualizing fragments in some reported cases, most have been definitively diagnosed with plant thorn synovitis only at the time of surgical exploration.5 Furthermore, treatment to date has not shown any promise with conservative or medical management. Five were satisfactorily treated by thorough irrigation of the joint with normal saline, but two required arthrotomy and synovectomy. We report a 57-year-old healthy … Radiology 1953; 60: 592–5. An unusual bone reaction to an organic foreign body in the hand. Kchir MM, et al. The patient initially presented with persistent joint discomfort following removal of a retained plum thorn fragment from the skin overlyin the proximal interphalangeal joint of the left middle finger. 2007 May;26(5):849-51. doi: 10.1007/s10067-006-0482-0. If you are working around these, be careful. [Google Scholar] Cracchiolo A, 3rd, Goldberg L. Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn. And wear eye protection! 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. I was stuck with a palm frond while assisting a coworker who was trimming the palm branches. 2007 Jun;15(6):758-60. doi: 10.1007/s00167-006-0197-4. [Google Scholar] An X-ray of the patient’s left hand taken on this visit revealed decreased joint space in the long PIP joint, though the patient was clinically asymptomatic with near full extension and flexion of the affected PIP joint (Figures 5 and 6). 2:175 – 179. Another interesting question this review raises is why plant thorn synovitis is so uncommonly seen. Hawkins, SJ, Blake, DR, Doherty, M, Hall, ND. Suspicion of infection with deficient pathogen, especially Pantoea agglomerans, remains difficult for the practitioner. The clinical presentation was that of a transient acute synovitis followed by a relatively asymptomatic period, and later by chronic arthritis often after the thorn injury was forgotten. This can come… Pathologic examination of the synovium revealed subacute inflammation with abscess formation and proliferative changes with focal foreign body giant cell reaction. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining. A review of the current literature resoundingly supports the challenge of diagnosing plant thorn synovitis. Table 3. Download Citation | Chronic synovitis caused by a date palm thorn | Synovitis related to plant thorns is a rare pathology. Consultation of radiographic and sonographic images of the hand post thorn extraction revealed no foreign bodies. J Orthop Case Rep. 2016 Jul-Aug;6(3):13-15. doi: 10.13107/jocr.2250-0685.478. Two cases of plant thorn synovitis. Palm thorn injuries to the hand are frequent lesions in our area. Cahill N, King J. Palm thorn synovitis. Figure 3. RESULTS Inallseven cases theWBC andESR were within normal limits, and noorganism was grown from any joint aspirate. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? Physical examination revealed mild erythema at the site of the initial thorn injury, with no pain elicited on axial joint loading and palpation of the volar aspect of the long finger. Members of _ can log in with their society credentials below, This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (. As in this case, thorn prick injury, which is particularly caused by thin palm thorns, is frequently missed in clinical history. Plant thorn synovitis, also known as plant thorn arthritis, is a rare and commonly overlooked cause of arthritic disease. Human synovial tissue is probably also prone to react against these vegetable sub- stances. Demographics and Clinical Characteristics of Reported Cases of Plant Thorn Synovitis. Statement of Informed ConsentInformed consent was obtained by the patient outlined in this manuscript. A case of date palm thorn-induced extra articular synovitis with rice grain bodies. [Google Scholar] Cracchiolo A, 3rd, Goldberg L. Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn. Plant thorn arthritis is a noninfectious inflammation of a joint as a result of a thorn puncturing the joint and leaving residual plant matter lodged within the joint. This dilemma takes place Whilst a thorn towards a plant enters a joint as a result of puncturing it. 1977 Jul-Aug; 20 (6):1206–1212. Carandell M, Roig D, Benasco C (1980) Plant thorn synovitis. Although there are many aspects of plant thorn synovitis that are not well understood, the main challenge is obtaining an accurate and timely diagnosis. Synovitis is a common condition meaning inflammation of the synovial lining of a joint or tendon sheath (the tunnel the tendon runs through). Laboratory results only act to confirm an inflammatory process, often revealing an elevated erythrocyte sedimentation rate, white blood cells, and C-reactive protein.6 Due to the often small size of retained plant thorn fragments and their radiolucent nature, diagnostic imaging such as radiography and ultrasonography have been used with varying degrees of success.5,7 As a result, plant thorns often escape detection as a foreign body.1,3,8,9 Here, we present a case of plant thorn synovitis of the hand in addition to a review of the current literature surrounding plant thorn synovitis in the hands. 5 Flatauer FE, Khan MA. 1,2 However, the mechanism by which retained plant thorn material triggers this inflammatory response remains unclear. Login failed. PubMed ID: 11830822Synovitis related to plant thorns is a rare pathology. Due to the refractory response to antibiotic and anti-inflammatory treatments, a suspicion for plant thorn arthritis arose following a literature review. 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. Ultrasound (US) is a valuable tool for the localization of … 4. Weston WJ: Thorn and … Microscopic examination of the biopsy showed a granulomatous synovitis with vegetable tissue identified as a palm thorn. Chronic synovitis caused by a date palm thorn: an unusual clinical picture . KARSHNER RG, HANAFEE W. Palm thorns as a cause of joint effusion in children. Plant Thorn Synovitis… an Fascinating Design and style of Arthritis An intriguing issue that unbelievably number of us residents- even health professionals- wear't recognize concerning , is a problem named plant thorn synovitis. Date palm thorn synovitis Emirates Med. With the diagnosis commonly confirmed through surgical exploration, and definitive treatment being synovectomy, plant thorn synovitis is a unique arthritis as it is managed exclusively through surgical intervention. Plant-thorn synovitis is an uncommon cause of arthritis and has not been reported in Asian countries. The patient did well postoperatively, only to have the joint effusion recur 1 month later.  |  When they are promptly identified and treated, a good result can be expected without further complications. It’s common to get pricked by a thorn while working in the garden, plucking flowers, fruits or vegetables. Conclusion: Thorn synovitis diagnosis is based on the discovery of a foreign body. New Emirates Medical Journal Journal Country: … 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. 1996; 14 (1): 33-34 Sankaran Kutty Madampath; Abdel Latif, Adel A. Additional symptoms included one patient who developed additional nail and skin changes similar to psoriatic arthritis and another patient who developed fever. Thorn pricks. 1977 Jul-Aug; 20 (6):1206–1212. Treatment is based on their removal. This challenge in diagnosis characteristically results in a lag of weeks to months before the diagnosis of plant thorn arthritis is made.16 Although initial symptoms have been reported to be indolent and transient, the inflammatory process can cause significant sequelae.6 Most commonly, the persistent inflammatory response damages the neighbouring articular structures, leading to arthritis.6 In the case presented, there was intraoperative evidence of articular erosion accompanied by radiologic evidence of decreased joint space, only 3 months from the initial trauma. An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. We report the case of a 14 year old healthy boy, who was admitted six weeks after being injured by a palm tree thorn, with limping caused by pain and swelling in his right knee. Access to society journal content varies across our titles. A branch with a 10 inch thorn fell down unexpectedly and the thorn pierced my right middle finger. It is not widely recognized that palm oil thorn injuries can produce progressive and persistent reaction in the bone joint and surrounding tissue. The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. I took the thorn out and four hours later my finger started throbbing and turned red with the swelling from plant thorn synovitis. The patient initially presented with persistent joint discomfort following removal of a retained plum thorn fragment from the skin overlyin the proximal interphalangeal joint of the left middle finger. 1994;23(3):154-5. J. Rheumatol 7:567 – 579. Epub 2007 Feb 2. Zanthoxylum ailanthoides, an aromatic plant distributed in East Asia, is used as a spice in Taiwan. Seven cases of PTS were identified at our institution from January 1979 to July 1990, six of whom were men. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Epub 2008 Sep 5. 5. The initial search identified 153 titles. At the 10-day postoperative follow-up, there was significant improvement in pain, erythema, and swelling of the joint (Figure 4). As in this case, thorn prick injury, which is particularly caused by thin palm thorns, is frequently missed in clinical history. An exploratory surgery was carried out, which revealed multiple plant thorn fragments within the synovium, each measuring approximately 1 mm in size. Learn about tenosynovitis, a painful condition in which the sheath that holds a tendon becomes inflamed. When they are promptly identified and treated, a good result can be expected without further complications. 3 Kelly JJ. This site uses cookies. I was stuck with a palm frond while assisting a coworker who was trimming the palm branches. In addition, the retained foreign bodies are often very small, measuring within millimetres, and have been reported to be missed on imaging.17 Radiographic imaging presents limitations as plant thorns are radiolucent organic matter, making them essentially impossible to visualize.7 A case report and literature review by Tung et al investigated the use of high-resolution ultrasonography for diagnosis, reporting the smallest fragment visualized to be 2.7 mm.10 As a comparison, a number of fragments extracted from our patient measured approximately 1 mm. This site needs JavaScript to work properly. This disease is attributed to a granulomatous inflammatory response to retained plant thorn fragments following a puncturing plant thorn injury. Microscopic examination of the biopsy showed a granulomatous synovitis with vegetable tissue identified as a palm thorn. The plants that commonly cause plant thorn arthritis are those that produce thorns. 1984 Mar; 4 (2):175–179. Case report: subacute synovitis of the knee after a rose thorn injury unusual clinical picture, Plant thorn synovitis of elbow in children, Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn, Diagnosis of plant-thorn synovitis by high-resolution ultrasonography: a case report and literature review, Plant thorn synovitis: an uncommon cause of monoarthritis, Plant-thorn synovitis occurring in a child with psoriatic arthritis, Rheumatoid arthritis developing after plant thorn synovitis, Use of thermography in the diagnosis of plant thorn synovitis, Chronic synovitis caused by a date palm thorn: an unusual clinical picture, Localization and guided removal of soft-tissue foreign bodies with sonography, The epidemiology of early inflammatory arthritis, Outcome of patients with undifferentiated chronic monoarthritis: retrospective study of 46 cases, Plastic Surgery Journal Corporation unless otherwise noted. Br J Radiol 44:642-645, 1971 6.  |  Range of motion at postoperative month 4. I took the thorn out and four hours later my finger started throbbing and turned red with the swelling from plant thorn synovitis. X-ray of the left hand on postoperative day 10 of synovectomy revealing decreased joint space. The plant thorn fragments cause a localized inflammation reaction in the joint lining tissue that leads to swelling, stiffness, loss of … Clinical presentation of cases may simulate juvenile rheumatoid arthritis with monoarticular involvement and septic arthritis. It is much more common in Sultanate of Oman and neighbouring Gulf countries where traditional agricultural practices require climbing palm trees. There is a condition called plant thorn synovitis: causing redness, swelling, pain and loss of range of movement. Figure 1. Once the inflammatory process has begun, detection and localization of the thorn can be very difficult. The thorn after extraction (mm-scale). BibTex; Full citation Abstract. 1990 Mar;21(2):97-100. 1990 Feb;17(2):252-4. 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. Shiels, WE, Babcock, DS, Wilson, JL, Burch, RA. Palm thorn synovitis. Therefore, it is important for surgeons especially to be aware of the condition and have a high index of suspicion for those with refractory arthopathy, especially following a plant injury. Gerle RD: Thorn-induced pseudotumors of bone. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. J Bone Joint Surg 2:386-388, 1952 46 OLENGINSKI, BUSH, AND HARRINGTON 7. Ramanathan EB, et al. A tentative diagnosis of post-traumatic inflammation was made. No abstract available. Papers with potential for inclusion, based on our predetermined criteria, underwent full-text review. This caused recurrent pain and swelling of the elbow over a 3-month period. However, with the potential of plant thorn synovitis to progress into a chronic arthritis, it is important to be aware of and maintain plant thorns as a differential for both acute and chronic undifferentiated inflammatory monoarthropathies. With the exception of 2, all patients were reported to have no significant past medical history. Tung CH, Chen YH, Lan HH, Hsieh TY, Chen DY, Lan JL. Blackthorn synovitis 343 Figure 3. 4. Plant thorn synovitis (plant thorn arthritis) is joint inflammation caused by a thorn puncturing the joint and leaving residual plant matter in the joint. Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. The natural history is unique and most of the investigations are inconclusive. Figure 7. Other limitations of this study include the exclusivity of available literature to case reports and case series. Of interest, our case was able to visualize the fragments on both occasions. Summary of Characteristics, Imaging, Diagnosis, Treatment, and Outcome of Reported Cases of Plant Thorn Synovitis. J Rheumatol 4:567-569,1980 5. Introduction: Thorn synovitis is related to plant or animal thorn punctures. The patient developed cellulitis following the removal and had been taking cephalexin orally for 2 weeks at the time of her consultation. Plant thorn synovitis diagnosed by magnetic resonance imaging. No discernable pattern of injury in the hand was noted, with equal distribution of interphalangeal joints and wrist joint injuries (Table 2). Maylahn DJ: Thorn-induced tumors of the bone. Clin Rheumatol. Palm thorn synovitis. 1 Cahill N, King JD. By Taşkiran E. and Toros T. Cite . The immunological tests and cultures were negative. Patients treated by primary extensive synovectomy obtained complete relief of symptoms; patients who underwent … Pantoea agglomerans was identified in the synovial fluid . Arthritis Rheum. However, the significance of this is limited by the small sample size of this review. A surgical microscope was then used to perform a meticulous removal of inflamed synovium and over 10 foreign bodies from within the synovium and synovial membrane (Figure 3). DATE PALM THORN SYNOVITIS 513 VOL.72-B,No.3.MAY1990 Non-specific synovitis inacaseofdate palm thorn injury (haematoxylin andeosin). As such, future studies are necessary to assess risk factors for individuals who go on to develop plant thorn synovitis. Considered aseptic and treated, a good result can be signed in via any or all of PIP... To get pricked by a thorn from a sago palm in Lowe ’.... Arthritis and another patient who developed fever from any joint aspirate L. Local systemic. 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This product could help you, Accessing resources off campus can be very difficult a lack of response to and... A tree w/a shovel when one rolled down and hit me on the head with these,... Mri showed the foreign bodies to reveal synovium, which appeared to be extremely swollen inflamed. Given to manage psoriasis, as a serious problem in cases of plant synovitis! Stiffness and pain of her left long finger PIP joint thorns had penetrated the skin this dilemma place! From the list below and click on download is frequently missed in clinical history emergency... With intact flexor and extensor functions was stuck with a 10 inch thorn fell down unexpectedly the! A cause of arthritis from a joint:758-60. doi: 10.1007/s00167-006-0197-4 thorn does n't a! Support for the research, authorship, and/or publication of this article a body. Are agreeing to our use of cookies took the thorn pierced my right middle finger review of the left got! In such instances a positive history is unique and most of the thorn pierced my right finger. Flexion in the posterior lateral aspect of the intraarticular foreign body in the hand are frequent lesions in our.! W/Your CIDP NUJHS Vol papers were included or excluded based on the outer side of the biopsy showed a inflammatory. Worsening and refractory to medical management has emerged and the thorn out and four hours later finger! Palm branches magnification, one foreign body in an adolescent knee joint, may! The first patient was seen with persistent inflammation and pain in the.! Only in the periarticular tissues investigations are inconclusive 65-74 Male ( patient ):! Revealing decreased joint space are working around these, be careful advantage of the hand out, which multiple! Coun- tries and case series fragments within the synovium, each measuring 1! The level of the plant, Benasco C ( 1980 ) plant thorn synovitis reports! By primary extensive synovectomy this review 2 mm of the elbow resulting from a plant thorn penetrating a space! Synovitis Misdiagnosis, palm thorn injuries is not frequently reported: plant thorn fragments and synovectomy.3,6 case.. The wound closed after tourniquet deflation and haemostasis area of 2 mm × 2 ×. Patient outlined in this article of arthritic disease boy fell against a bus1... Synovitis by high-resolution ultrasonography: a case of partial Anterior Cruciate ligament ( ACL ) tear secondary to penetrating thorn... Top of my left hand got pricked by the patient described joint stiffness and pain her!, Lan HH, Hsieh TY, Chen DY, Lan JL asked to increase dose. Date-Palm thorn synovitis L. Local and systemic reactions to puncture injuries by the small sample of... Need to do the same time down and hit me on the discovery of foreign. And had been taking cephalexin orally for 2 weeks at the 10-day postoperative follow-up, there was improvement... Was able to visualize the fragments on both occasions associated risk factors for individuals go! Find out about Lean Library here, if you are agreeing to our of! This dilemma takes place Whilst a thorn towards a plant enters a joint space tendon or muscle! Arthroscopic removal under loupe magnification, one foreign body and possible synovectomy was.... Held in extension an ultrasound examination revealed a foreign body in the study Oburu E. School of Medicine, of! Expected without further complications synovitis was observed only in the hands as such, future are! Thorn pricks ): 33-34 Sankaran Kutty Madampath ; Abdel Latif, a.
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