Tuberculous tenosynovitis is a rare extrapulmonary manifestation of tuberculosis and often presents with nonspecific symptoms that mimic more common inflammatory or degenerative conditions. We report a unique case from Eastern Morocco involving a 39-year-old male with a two-year history of progressive swelling and limited flexion of the wrist and the second, third, and fifth fingers. Imaging revealed tenosynovitis of the flexor tendons, and histopathological examination confirmed tuberculosis through the presence of granulomatous inflammation with caseous necrosis. The patient underwent a surgical synovectomy followed by a six-month course of anti-tuberculosis therapy, resulting in significant clinical improvement and restored joint mobility. This case underscores the importance of considering tuberculosis in the differential diagnosis of chronic tenosynovitis, particularly in endemic regions. It highlights the role of early histopathological confirmation and combined medical-surgical management in achieving favorable outcomes.