From: Sudhir Warrier <swarrier@vsnl.com>
Date: March 30, 1999 4:59 PM
Krishnan is right! I have heard at least three papers on "Date Palm Thorn Synovitis".These papers were from the Khoula Hospital, Muscat, Oman. One of the authors was Lewis, (Luis, Editor's note) who moved on to Australia, I believe.
E.B.S.Ramanathan and Wahid-al-Kharusi were the other authors. The condition was noted in people who climbed date palms professionally. I will try and get more information on this.

Sudhir Warrier                                                         
Hand & Reconstructive Orthopedic Surgeon                  
Shushrusha Hospital  &  Laud Clinic
                         
Res:B, Block, Hare Krishna Land, Juhu,                            
Mumbai-400049  India

From: kklou <kklou@tm.net.my>
Date: March 31, 1999 4:05 AM
                  In Malaysia, I have seen quite a number of oil palm plantation workers who had injuries
to various parts of their bodies by the oil palm thorns. They present typically with a very localised ,
severe inflammatory reaction. Occasionally it leads to an abscess collection which is easily diagnosed
and treated. 
                 Most of them however insist that the thorns have been removed, but the pain and stiffness
persist and local examination reveals an area of mild to moderate induration only. X-ray normally
does not pick up the foreign body, so most of the time, I proceed to explore the old injury and find
the foreign body. Not easy though! The ones with abscess usually come back as Staph. aureus on
culture but I have never before taken tissue from the non-abscess wounds to check for infection.
They all usually settle once the thorns are removed. 
                However the incidence of knee injury by thorns is not so common here because the plants
here are above shoulder height and the common sites are hands and fingers (that would include the
smaller joints). 
                IMHO, fungal infection may be common because the thorns are usually covered with
spores and whatever pollen material that fly around  in the air. Staph. aureus is the main organism in
my area because the patients initially will try their best to dig out or pull out the thorns, that's when
the puncture wounds get infected. 
K.K. Lou, 
Penang Seventh Day Adventist Hospital, 
Penang,Malaysia.

From: Jose M. Palomo Traver <jmpalomo@comcas.es>
Date: March 31, 1999 3:03 PM
We ( North to Valencia, Eastern Spain ) have quite a large and all too similar experience with thorns of both palm and orange trees.
     Jose M. Palomo, MD
     Med. Adjunto ( Consultant Trauma & Orth. Surgeon )
     Castello General Hospital
     SPAIN

From Myles Clough mylesclough@shaw.ca
Date April 1st 1999
A number of points ;-) emerged from the literature review -
1. A large number of the cases present as a chronic synovitis. Often, especially with small children, the original injury had been forgotten. Some of the rheumatology papers say "Bear this possibility in mind when faced with a monoarthritis"
2. A number of papers suggest that complete synovectomy is required and that wash-out or simple removal of the thorn is not enough. I suspect this may be related to the chronicity of the cases and hope that in my (sub-acute) case it will not be necessary. Another of the pictures taken during my case shows the hyperaemia of the synovium and the presumed entry site of the cactus spine. Do people think this degree of synovitis will be a chronic problem?
3. The largest collection of cases published was 20 from India. However, some of the list members who corresponded suggest that the condition is quite common.
4. The bacteriology is very varied with no organism predominating. Dr Lou from Malaysia suggested that Staph aureus was common but only because most of the patients had tried to dig the thorn out themselves and got a secondary infection. I'm not sure if the consensus is that the synovitis is of microbial aetiology or is a hypersensitivity reaction to the foreign body.
5. CT scan was recommended where this diagnosis is suspected as it is much more likely to demonstrate the presence of an intraarticular thorn than plain xrays. There is one report of MR scanning showing up the object really well.
6. I found it amusing how many different people claim priority in the arthroscopic diagnosis and treatment of this condition.