OBJECTIVE: To investigate the clinical characteristics of primary tendon sheath tuberculosis of the hand and foot, the diagnosis of tendon sheath swelling and the key points of treatment. METHODS: From October 2002 to March 2009, six patients with nuclear tenosynovitis of the hand, wrist and foot and ankle were treated with a combination of surgery, anti-tuberculosis drugs and functional exercise, and their clinical efficacy, causes of misdiagnosis and points of diagnosis and treatment were analyzed. Results: All cases were cured. The postoperative follow-up ranged from 1 to 6 years, with satisfactory results in 5 cases and partial functional limitation in 1 case due to 2 recurrences. CONCLUSION: The diagnosis of tuberculous tenosynovitis relies on simultaneous analysis of clinical manifestations and laboratory tests. Timely lesion debridement, together with a combination of systemic anti-tuberculosis drugs and functional exercises, can lead to complete cure.