Idiopathic Tenosynovitis with Rice Bodies: Clinical Case Report

Introduction: Tenosynovitis is the main cause of pain in the upper limbs; it can be originated from infectious and non-infectious causes. 50% of reported cases are tuberculous tenosynovitis. When the rice body formation pathogenesis is uncertain after performing all extension studies, it is called idiopathic tenosynovitis. Clinical Case: A 79- year-old male patient with a pathological history of chronic ischemic heart disease treated with cardiac catheterization with stent placement comes to the Plastic Surgery Office due to the presence of multiple masses on the back of the right hand in zone V, VI and VII with 3 years of evolution, without significant accompanying symptoms. Physical examination revealed the presence of multiple non-painful mobile masses of approximately 4x5cm in the extensor zone V, VI and VII of the right hand. In the surgical exploration for biopsy, within the macroscopic characteristics, multiple converging and interconnected masses were found with granular content infiltrating sheath and tendon itself (II, III, IV and V fingers of the right hand). Posterior capsule of masses is in contact with intrinsic and interosseous muscles of the right hand with the appearance of rice bodies. At the moment, the patient shows a favorable evolution and continues in periodic controls. Conclusions: In this case, having no underlying diseases related to this pathology and having ruled out among the differential diagnoses, it was determined that the occurrence of rice body masses in an infiltrative manner in the tendons is of an idiopathic origin, so our patient will remain on long-term follow-up, but so far with favorable evolution.