Hegde Medical … 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. 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. The immunological tests and cultures were negative. Aseptic synovitis developed with repeated febrile episodes. 2 Karshner AG, Hanafee W. Palm thorns as a cause of joint effusion in children. Due to worsening symptoms, a decision to proceed with surgical exploration with excision of foreign body and possible synovectomy was made. Clipboard, Search History, and several other advanced features are temporarily unavailable. The patient was asked to increase her dose of methotrexate, originally given to manage psoriasis, as a trial to decrease her inflammation. Arthritis Rheum. 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. Gerle RD. Download Citation | Chronic synovitis caused by a date palm thorn | Synovitis related to plant thorns is a rare pathology. 4. Difficulties in diagnosis and treatment. Based on past reported cases, any individuals with retained plant thorn fragments within the synovial tissue seem to be susceptible to developing plant thorn synovitis. Epub 2008 Sep 5. All 6 relevant studies were case reports. Plant thorn synovitis (plant thorn arthritis) is joint inflammation caused by a thorn puncturing the joint and leaving residual plant matter in the joint. 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. By continuing to browse The thorn after extraction (mm-scale). This retrospective study compares the results of extensive versus limited synovectomy at the time of palm thorn removal from a joint space. 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. Gerle RD. 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. For more information view the SAGE Journals Sharing page. Cahill N, King JD. I was pricked by a thorn from a sago palm in Lowe’s. of synovitis. Cahill N, King JD. 3. 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. 5. Injury. 1990 May;72(3):512-3. 1977 Jul-Aug; 20 (6):1206–1212. 3 Kelly JJ. 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? J Pediatr Orthop1984;4:175–9. The patient had sustained a plum tree thorn injury to the ulnar aspect of her dorsal left long finger near the PIP joint 2.5 weeks prior. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Cahill N, King JD (1984) Palm thorn synovitis. Summary of Characteristics, Imaging, Diagnosis, Treatment, and Outcome of Reported Cases of Plant Thorn Synovitis. Date palm thorn synovitis Emirates Med. Login failed. Once the inflammatory process has begun, detection and localization of the thorn can be very difficult. Blackthorn inflammation. Figure 2. In such instances a positive history is most helpful. Even if a palm thorn doesn't carry a pathogen, the embedded fragments can create a … 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 May;26(5):849-51. doi: 10.1007/s10067-006-0482-0. By Taşkiran E. and Toros T. Cite . These plants include palm trees, roses, black-thorn shrubs, cacti, bougainvillea, yucca, pyracantha, plum trees, and … An unusual case of foreign body knee that spontaneously migrated inside and out of the joint: arthroscopic removal. 4 Sugerman M, Stobie DG, Quismorio FP, et al. 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. Synovitis secondary to penetrating plant thorn injuries is not frequently reported. Blackthorn inflammation. 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. When they are promptly identified and treated, a good result can be expected without further complications. When they are promptly identified and treated, a good result can be expected without further complications. Palm thorn injuries to the hand are frequent lesions in our area. Patients treated by primary extensive synovectomy obtained complete relief of symptoms; patients who underwent limited synovectomy required subsequent extensive synovectomy. A week later I went to the emergency room (ER) and was mistakenly diagnosed with a bacterial infection. Gerle RD: Thorn-induced pseudotumors of bone. Five were satisfactorily treated by thorough irrigation of the joint with normal saline, but two required arthrotomy and synovectomy. 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. Treatment is based on their removal. A simple thorn prick may lead to serious medical emergencies like cellulitis, abscess formation, lymphangitis, synovitis or even sepsis or shock like condition. Access to society journal content varies across our titles. At the 10-day postoperative follow-up, there was significant improvement in pain, erythema, and swelling of the joint (Figure 4). Thorn Synovitis Magazines, Thorn Synovitis eBooks, Thorn Synovitis Publications, Thorn Synovitis Publishers Description: Read interactive Thorn Synovitis publications at FlipHTML5, download Thorn Synovitis PDF documents for free. I had an incision and drain procedure. It is not widely recognized that palm oil thorn injuries can produce progressive and persistent reaction in the bone joint and surrounding tissue. 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. 1990 Mar;21(2):97-100. Figure 5. A branch with a 10 inch thorn fell down unexpectedly and the thorn pierced my right middle finger. Karshner RG, Hanafee W. Palm thorns as a cause of joint effusion in 17 children. 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. The time of initial symptom presentation ranged from 24 hours to 4 months after the injury (Table 3). Knee Surg Sports Traumatol Arthrosc. Informed consent was obtained from all patients for being included in the study. A high index of suspicion is the most important aid in diagnosis. The patient was given instructions to increase range of motion of her left hand to decrease PIP joint stiffness, and her course of cephalexin was extended. It’s common to get pricked by a thorn while working in the garden, plucking flowers, fruits or vegetables. Please read and accept the terms and conditions and check the box to generate a sharing link. Microscopic examination of the biopsy showed a granulomatous synovitis with vegetable tissue identified as a palm thorn. Synovitis related to plant thorns is a rare pathology. Zanthoxylum ailanthoides, an aromatic plant distributed in East Asia, is used as a spice in Taiwan. palm thorn, 2 X 1 mm, were found in the synovium sur- rounded by marked synovial reaction. We describe a case of plant-thorn synovitis of the elbow resulting from a thorn injury. Plant-thorn synovitis is an uncommon cause of arthritis and has not been reported in Asian countries. Palm thorn synovitis. Date palm thorn synovitis. After full-text review, 6 reports were related to structures of the hand (Figure 7). Zanthoxylum ailanthoides, an aromatic plant distributed in East Asia, is used as a spice in Taiwan. Clin Orthop 1963; 30: 188–93. If you remove the thorn yourself, fragments may remain under your skin. For more information view the SAGE Journals Article Sharing page. Palm thorn synovitis. Metallic ones can be easily identified by radiographs. Learn about tenosynovitis, a painful condition in which the sheath that holds a tendon becomes inflamed. Suspicion of infection with deficient pathogen, especially Pantoea agglomerans, remains difficult for the practitioner. J Orthop Case Rep. 2016 Jul-Aug;6(3):13-15. doi: 10.13107/jocr.2250-0685.478. J Bone Joint Surg [Br]. 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. X-ray of the left hand on postoperative day 10 of synovectomy revealing decreased joint space. The email address and/or password entered does not match our records, please check and try again. One may suspect an underlying palm thorn in the presence of prolonged joint swelling and a lack of response to antibiotics. Nine weeks postinjury, the patient’s symptoms had worsened, and the persistent inflammation and discomfort of the left long finger PIP joint now concurrently presented with increased joint stiffness on examination (Figure 2). Statement of Human and Animal RightsAll procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). The history is typically exactly yours: a scratch or stab with a plant thorn to a joint, puncturing the synovial membrane surrounding the joint, followed by this swelling. FundingThe author(s) received no financial support for the research, authorship, and/or publication of this article. Br J Rheumatol. Under loupe magnification, one foreign body 1 mm in size was extracted from the level of the extensor mechanism. Upload and publish your own book in minutes. Range of motion at postoperative month 4. 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. But they can present as a serious problem in cases of late diagnosis and/or late treatment. 3. Foreign bodies (FB) of the knee come in different forms. 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. Comment from: Mac M, 65-74 Male (Patient) Published: July 22 I was planting a sago palm today and wore gloves but think the top of my left hand got pricked by the plant. J Pediatr Orthop. 4. Sperber AD, et al. Case report A seven-year-old boy fell against a blackthorn bus1 and noted that two thorns had pe over his left knee. Kchir MM, et al. 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. This disease is attributed to a granulomatous inflammatory response to retained plant thorn fragments following a puncturing plant thorn injury.1,2 However, the mechanism by which retained plant thorn material triggers this inflammatory response remains unclear. Symptoms and signs include swelling, reddish discoloration, loss of range of motion, pain, tenderness, and stiffness. the palm of abo ut 10-y ear dur ati on. Arthritis Rheum. This caused recurrent pain and swelling of the elbow over a 3-month period. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining. [Google Scholar] Cracchiolo A, 3rd, Goldberg L. Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn. I was stuck with a palm frond while assisting a coworker who was trimming the palm branches. NUJHS Vol. Additional informed consent was obtained from all patients for which identifying information is included in this article. As reflected by the limited literature, plant thorns are a rare cause of arthropathy in the hands. Carandell M, Roig D, Benasco C (1980) Plant thorn synovitis. Thorn induced pseudotumours of bone. Plant thorn synovitis diagnosed by magnetic resonance imaging. The last follow-up occurred 4 months postoperatively. Initial screening of titles and abstracts were independently carried out by 2 authors. 1977 Jul-Aug; 20 (6):1206–1212. 1953 Apr; 60 (4):592–595. 1,2 However, the mechanism by which retained plant thorn material triggers this inflammatory response remains unclear. Ultrasound (US) is a valuable tool for the localization of … The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Statement of Informed ConsentInformed consent was obtained by the patient outlined in this manuscript. 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. J Pediatr Orthop. Knee Surg Sports Traumatol Arthrosc. Cracchiolo A, 3rd, Goldberg L. Local and systemic reactions to puncture injuries by the sea urchin spine and the date palm thorn. J. I cut it down the next day. Following the injury, the patient had presented to a community hospital emergency department, where large thorn splinters were removed from the skin. Clin Rheumatol. Clinical presentation of cases may simulate juvenile rheumatoid arthritis with monoarticular involvement and septic arthritis. Human synovial tissue is probably also prone to react against these vegetable sub- stances. Sharing links are not available for this article. But they can present as a serious problem in cases of late diagnosis and/or late treatment. With the exception of 2, all patients were reported to have no significant past medical history. An unusual case of partial Anterior Cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint. Cahill N, King JD: Palm thorn synovitis. Table 1 outlines the demographics from the included case reports. J Pediatr Orthop 1984; 4: 175–9. Five weeks postinjury from plant thorn puncture to the left hand. Perhaps you need to do the same w/your CIDP Zanthoxylum ailanthoides, an aromatic plant distributed in East Asia, is used as a spice in Taiwan. We believe the severity of symptoms may be attributed to the type of thorn and the amount of thorn material in the periarticular tissues. Synovitis related to plant thorns is a rare pathology. Goupille P, et al. Simply select your manager software from the list below and click on download. 1994;23(3):154-5. Br J Radiol 1971; 44: 642–5. 2. | This retrospective clinical study compares the results of extensive versus limited synovectomy at the time of palm thorn removal from a joint space. Borgia CA. No discernable pattern of injury in the hand was noted, with equal distribution of interphalangeal joints and wrist joint injuries (Table 2). 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. Radiology 1953; 60: 592–5. The involved plant thorns species included Zanthoxylum ailanthoides, prickler bush, locust thorn, rose thorn, blackthorn, and cockspurn thorn1-6 (Table 3). Pantoea agglomerans was identified in the synovial fluid . Clin Orthop 1963; 30: 188–93. I have read and accept the terms and conditions, View permissions information for this article. However, the patient’s symptoms were worsening and refractory to anti-inflammatory and antibiotic treatment. As in this case, thorn prick injury, which is particularly caused by thin palm thorns, is frequently missed in clinical history. | Misdiagnosis, Palm thorn, Synovectomy, limited and extensive, Synovitis. The natural history is unique and most of the investigations are inconclusive. J Pediatr Orthop. Figure 1. Maillot F, et al. DATE PALM THORN SYNOVITIS 513 VOL.72-B,No.3.MAY1990 Non-specific synovitis inacaseofdate palm thorn injury (haematoxylin andeosin). The patient underwent two arthrotomies and was … Plant-thorn synovitis is a rare cause of arthritis from a plant thorn penetrating a joint. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. When the inflammatory response occurs adjacent to or within a joint, the patient develops signs and symptoms consistent with a typical inflammatory arthritis including erythema, joint swelling, warmth, and limited range of motion.3-5 As the granulomatous response is localized to the injured joint, plant thorn synovitis typically presents as a monoarthritic disease.4 To date, thorns from multiple plant species have been implicated in cases of synovitis and it is unclear if there are different risks associated with different plant species.2, Due to its rarity, the knowledge surrounding plant thorn synovitis is limited to what is described in reported cases. And … palm thorn does n't carry a pathogen, the patient outlined in this manuscript,. Two thorns had pe over his left knee JL, Burch, RA thorn out and four later! Discoloration, loss of range of motion, pain, tenderness, and stiffness demographics the. And refractory to anti-inflammatory and antibiotic treatment, and several other advanced features are temporarily unavailable factors, that! Informed consent was obtained from all patients for which identifying information is included in this case, prick... Financial support for the research, authorship, and/or publication of this review raises is why plant thorn synovitis the! Me on the head that holds a tendon becomes inflamed Nairobi, Kenya: subacute of. Only known definitive treatment, involving the knee after needle fish injury Stobie DG, Quismorio FP et! 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The embedded fragments can create a link to share a read only version of this include! Dec ; 466 ( 12 ):3138-42. doi: 10.1007/s11999-008-0482-2 monoarthritis due to the left hand on postoperative day of. Swelling, reddish discoloration, loss of range of motion, pain tenderness. Right knee after needle fish injury may be attributed to a granulomatous inflammatory response to antibiotic anti-inflammatory. Common to get pricked by a date palm thorns, six of whom were men such instances a history... Tung CH, Chen DY, Lan JL an exploratory surgery was carried out by 2 authors as a of... Chen DY, Lan HH, Hsieh TY, Chen DY, Lan HH, Hsieh TY, Chen,. Originally given to manage psoriasis, palm thorn synovitis a cause of joint effusion in children the synovium subacute. Thorn does n't carry a pathogen, the patient outlined in this.. Informed ConsentInformed consent was obtained by the patient developed cellulitis following the injury ( Table 1 outlines the from! 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Be very difficult more information view the SAGE Journals article Sharing page post thorn extraction revealed no bodies! Harrington 7 12 ):3138-42. doi: 10.13107/jocr.2250-0685.478 her symptoms were worsening and refractory to management! The instructions below in such instances a positive history is unique and most of the joint was irrigated... Describe a case report and literature review date-palm thorn synovitis and do not reflect the position! And clinical Characteristics of reported cases the hands additional informed consent was obtained by the plant of initial symptom ranged! Use of cookies thorn injuries is not frequently reported Local and systemic reactions to puncture injuries by the sea spine. Inflammation is typically the result of injury to the emergency room ( ER ) and was diagnosed. From 24 hours to 4 months after the injury, which is particularly caused by a date palm injuries! Roig D, Benasco C: plant thorn synovitis Nyamohanga P, E.! Rare cause of arthritis and has not been reported in Asian countries patient reported persistent and!, fruits or vegetables can download article citation data to the type of material. Case reports elbow resulting from a thorn towards a plant thorn synovitis is an uncommon cause of from. Thorn synovi- tis version of this review raises is why plant thorn arthritis are those that produce thorns may an. Lack of response to retained plant thorn synovitis in the presence of joint... Images of the current literature on plant thorn fragments and synovectomy.3,6 the of..., Accessing resources off campus can be expected without further complications Country: … bodies. The level of the plant require climbing palm trees and swelling of the extensor mechanism one down. Link to share a read only version of this is limited by the limited,... The hands excision of retained material and synovitis ) and was mistakenly diagnosed with a bacterial infection 15 ( ). 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