Ormerod, AD, White, MI, Eastmond, CJ, Chesney, RB. J Bone Joint Surg1966;48-B:474–7. With the exception of 2, all patients were reported to have no significant past medical history. The 2 patients with a reported past medical history includes a 58-year-old female with insulin-dependent type 2 diabetes mellitus and a 10-year-old male with a history of psoriasis.2,5. You need to be watchful. Another interesting question this review raises is why plant thorn synovitis is so uncommonly seen. 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. 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). 1,2 However, the mechanism by which retained plant thorn material triggers this inflammatory response remains unclear. We have reviewed seven cases of synovitis caused by date palm thorns, six involving the knee and one the ankle. Our case of plant thorn synovitis is discussed along with a review of the current literature on plant thorn synovitis in the hands. 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. Search for Similar Articles You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search. Radiology. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. A synovectomy was performed and the patient recovered with full function. 4 Sugerman M, Stobie DG, Quismorio FP, et al. J Pediatr Orthop1984;4:175–9. Polarized light microscopy facilitated identification of the plant tissue within the synovium. J Orthop Case Rep. 2016 Jul-Aug;6(3):13-15. doi: 10.13107/jocr.2250-0685.478. 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. Introduction: Thorn synovitis is related to plant or animal thorn punctures. Epub 2006 Sep 12. After arthrotomy, the joint was thoroughly irrigated with an angiocatheter. Sugarman, M, Stobie, DG, Quismorio, FP, Terry, R, Hanson, V. Stevens, KJ, Theologis, T, McNally, EG, Stevens, K. Tung, CH, Chen, YH, Lan, HH, Hsieh, TY, Chen, DY, Lan, JL. Seven cases of PTS were identified at our institution from January 1979 to July 1990, six of whom were men. Synovitis related to plant thorns is a rare pathology. Five weeks postinjury, the patient was seen with persistent inflammation and pain of her left long finger PIP joint (Figure 1). Statement of Informed ConsentInformed consent was obtained by the patient outlined in this manuscript. 2007. Epub 2007 Feb 2. Arthritis Rheum1977;20:1125–8. Thorn induced pseudotumours of bone. Hegde Medical … Date palm thorn synovitis. In addition, there is little current literature available, with the most recently reported case of plant thorn synovitis in the hands being from 2007. 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. 1977 Jul-Aug; 20 (6):1206–1212. The patient did well postoperatively, only to have the joint effusion recur 1 month later. 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. 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. Borgia CA. The patient was asked to increase her dose of methotrexate, originally given to manage psoriasis, as a trial to decrease her inflammation. PubMed ID: 11830822Synovitis related to plant thorns is a rare pathology. As reflected by the limited literature, plant thorns are a rare cause of arthropathy in the hands. Gerle RD. An unusual bone reaction to an organic foreign body in the hand. Case report: subacute synovitis of the knee after a rose thorn injury: unusual clinical picture. The plants that commonly cause plant thorn arthritis are those that produce thorns. Pathologic examination of the synovium revealed subacute inflammation with abscess formation and proliferative changes with focal foreign body giant cell reaction. Introduction: Thorn synovitis is related to plant or animal thorn punctures. 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. After full-text review, 6 reports were related to structures of the hand (Figure 7). Figure 4. 1953 Apr; 60 (4):592–595. 1977 Jul-Aug; 20 (6):1206–1212. We describe a case of plant-thorn synovitis of the elbow resulting from a thorn injury. Br J Radiol 44:642-645, 1971 6. Cahill N, King J. Palm thorn synovitis. Karshner RG, Hanafee W. Palm thorns as a cause of joint effusion in 17 children. Both were imm but the boy said that some thorn remnants were still J Bone Joint Surg1966;48-B:474–7. Plant thorn synovitis (plant thorn arthritis) is joint inflammation caused by a thorn puncturing the joint and leaving residual plant matter in the joint. I was pricked by a thorn from a sago palm in Lowe’s. 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. 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. 4 Sugerman M, Stobie DG, Quismorio FP, et al. Radiology. Radiology 1953; 60: 592–5. Figure 2. palm thorn, 2 X 1 mm, were found in the synovium sur- rounded by marked synovial reaction. Two cases of plant thorn synovitis. I had an incision and drain procedure. 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. 3. Carandell M, Roig D, Benasco C: Plant thorn synovi- tis. The email address and/or password entered does not match our records, please check and try again. Figure 5. 1 Cahill N, King JD. View or download all the content the society has access to. Case reports: The first patient was a 41-year-old-woman who presented with recurrent arthritis of the right knee after needle fish injury. J Rheumatol. Thorn pricks. 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. I have read and accept the terms and conditions, View permissions information for this article. Br J Rheumatol. 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. 1984 Mar; 4 (2):175–179. Clin Orthop Relat Res. We believe the severity of symptoms may be attributed to the type of thorn and the amount of thorn material in the periarticular tissues. An unusual case of foreign body knee that spontaneously migrated inside and out of the joint: arthroscopic removal. Maylahn DJ: Thorn-induced tumors of the bone. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. At present, surgical intervention is the only known definitive treatment, involving the open excision of plant thorn fragments and synovectomy.3,6. In a nonindustrial accident in 1973, a 2-year-old girl was killed and her aunt injured when they were struck by a hail of 57 coconuts falling from palm trees on Waikiki Beach, Hawaii.1 Secondary infection is common around traumatically implanted thorns, needles, or spines. Plant-thorn synovitis is an uncommon cause of arthritis and has not been reported in Asian countries. Microscopic examination of the biopsy showed a granulomatous synovitis with vegetable tissue identified as a palm thorn. 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. 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. Table 1 outlines the demographics from the included case reports. A branch with a 10 inch thorn fell down unexpectedly and the thorn pierced my right middle finger. Due to worsening symptoms, a decision to proceed with surgical exploration with excision of foreign body and possible synovectomy was made. Difficulties in diagnosis and treatment. By Taşkiran E. and Toros T. Cite . Cahill N, King JD (1984) Palm thorn synovitis. Demographics and Clinical Characteristics of Reported Cases of Plant Thorn Synovitis. Chronic synovitis caused by a date palm thorn: an unusual clinical picture . 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. Even if a palm thorn doesn't carry a pathogen, the embedded fragments can create a … The time of initial symptom presentation ranged from 24 hours to 4 months after the injury (Table 3). The tendon was reapproximated and the wound closed after tourniquet deflation and haemostasis. I was stuck with a palm frond while assisting a coworker who was trimming the palm branches. HHS Aseptic synovitis developed with repeated febrile episodes. wound wasclosed. Once the inflammatory process has begun, detection and localization of the thorn can be very difficult. When they are promptly identified and treated, a good result can be expected without further complications. 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. 1990 May;72(3):512-3. Palm thorn injuries to the hand are frequent lesions in our area. However, the significance of this is limited by the small sample size of this review. Synovitis related to plant thorns is a rare pathology.  |  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. Plant-thorn synovitis is an uncommon cause of arthritis and has not been reported in Asian countries. (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. Perhaps you need to do the same w/your CIDP Range of motion at postoperative month 4. Other limitations of this study include the exclusivity of available literature to case reports and case series. Date palm thorn synovitis Emirates Med. If you are working around these, be careful. 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). 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. A volar splint was placed with PIP held in extension. Knee Surg Sports Traumatol Arthrosc. 4. Knee Surg Sports Traumatol Arthrosc. Clin Orthop 1963; 30: 188–93. Plant thorn synovitis. J Pediatr Orthop. An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. Plant-thorn synovitis is a rare cause of arthritis from a plant thorn penetrating a joint. X-rays and MRI showed the foreign bodies in the soft parts on the outer side of the knee. No complications were noted. Although there are many aspects of plant thorn synovitis that are not well understood, the main challenge is obtaining an accurate and timely diagnosis. When they are promptly identified and treated, a good result can be expected without further complications. Clinical presentation of cases may simulate juvenile rheumatoid arthritis with monoarticular involvement and septic arthritis. It’s common to get pricked by a thorn while working in the garden, plucking flowers, fruits or vegetables. Radiology 1953; 60: 592–5. Inaoui, R, Bertin, P, Preux, P-M, Trèves, R. View or download all content the institution has subscribed to. 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/. By continuing to browse Clin Rheumatol. Due to the refractory response to antibiotic and anti-inflammatory treatments, a suspicion for plant thorn arthritis arose following a literature review. No previously published studies have alluded to associated risk factors, whether that be patient characteristics, past medical history, or plant species. Date Palm Synovitis Joint inflammation associated with intra-articular retention of a date palm thorn. Palm Thorn Synovitis. A branch with a 10 inch thorn fell down unexpectedly and the thorn pierced my right middle finger. Radiology1953;60:592–5. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. As in this case, thorn prick injury, which is particularly caused by thin palm thorns, is frequently missed in clinical history. All 6 relevant studies were case reports. 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. Sperber AD, et al. Symptoms and signs include swelling, reddish discoloration, loss of range of motion, pain, tenderness, and stiffness. 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. Presenting symptoms described were largely consistent between the reported cases. No discernable pattern of injury in the hand was noted, with equal distribution of interphalangeal joints and wrist joint injuries (Table 2). I took the thorn out and four hours later my finger started throbbing and turned red with the swelling from plant thorn synovitis. I took the thorn out and four hours later my finger started throbbing and turned red with the swelling from plant thorn synovitis. Shiels, WE, Babcock, DS, Wilson, JL, Burch, RA. [Synovitis Blackthorn synovitis is rare, and to the authors' knowledge no previous case has been described from the Scandinavian coun- tries. A high index of suspicion is the most important aid in diagnosis. We report two cases of thorn synovitis. A tentative diagnosis of post-traumatic inflammation was made. The thorn after extraction (mm-scale). 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. Plant Thorn Synovitis: An Uncommon Cause of Monoarthritis By Thomas P. Olenginski, David C. Bush, and Thomas M. Harrington Plant thorn synovitis (PTS) is an uncommon cause of monoarthritis. A simple thorn prick may lead to serious medical emergencies like cellulitis, abscess formation, lymphangitis, synovitis or even sepsis or shock like condition. We report a 57-year-old healthy … An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. One may suspect an underlying palm thorn in the presence of prolonged joint swelling and a lack of response to antibiotics. 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. A week later I went to the emergency room (ER) and was mistakenly diagnosed with a bacterial infection. 1984 Mar; 4 (2):175–179. Olenginski, TP, Bush, DC, Harrington, TM. In such instances a positive history is most helpful. J Bone Joint Surg 2:386-388, 1952 46 OLENGINSKI, BUSH, AND HARRINGTON 7. J Pediatr Orthop 1984; 4: 175–9. J Pediatr Orthop 1984; 4: 175–9. Carandell M, Roig D, Benasco C (1980) Plant thorn synovitis. Cahill N, King JD. Synovitis is a common condition meaning inflammation of the synovial lining of a joint or tendon sheath (the tunnel the tendon runs through). Palm thorn synovitis. Figure 7. USA.gov. Case report A seven-year-old boy fell against a blackthorn bus1 and noted that two thorns had pe over his left knee. Manuscript content on this site is licensed under Creative Commons Licenses, Plant Thorn Synovitis of the Hand in an Adult Patient: A Case Report and Review of the Current Literature, http://www.creativecommons.org/licenses/by-nc/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage. The initial search identified 153 titles. But they can present as a serious problem in cases of late diagnosis and/or late treatment. Palm thorn synovitis. Following the injury, the patient had presented to a community hospital emergency department, where large thorn splinters were removed from the skin. I cut it down the next day. Table 2. Pantoea agglomerans was identified in the synovial fluid . No abstract available. Comment from: Mac M, 65-74 Male (Patient) Published: July 22. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. J Pediatr Orthop. 3 Kelly JJ. 4, No.4, December 2014, ISSN 2249-7110 Nitte University Journal of Health ScienceCase ReportMONOARTICULAR SYNOVITIS OF KNEE DUE TO UNRECOGNISED INTRA-ARTICULAR PLANT SPLINTER Siddharth M. Shetty1, Vikram Shetty2, Arjun Ballal3 & Jayaprakash Shetty4 1,2Associate Professors, 3Post Graduate, 4Professor, Department of Orthopaedic Surgery, K.S. 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