Clinical features and treatment outcome of wrist tuberculosis in adult- a retrospective study of 84 consecutive cases with minimum of 2 years follow up

Abstract

Background Wrist tuberculosis (TB) is a rare disease that may result in residual deformity, pain, or stiffness even after proper antitubercular chemotherapy (ATT) and surgical intervention. The aim of our study is to present clinical features and functional outcomes of wrist TB in a consecutive series of 84 adult patients with a minimum of 2 years of follow-up. Methods Clinical features and treatment outcomes of 84 consecutive adult patients with wrist TB from January 2003 to June 2018 including 45 men and 39 women, with a mean age of 46.8 years (18–84) were retrospectively analyzed. Data were collected on participants’ demographic details. The primary outcome measures were QuickDASH score, grip strength, Visual Analogue Scale (VAS), and PRWHE. Secondary outcomes include health-related quality of life was evaluated using the EuroQol five-dimension five-level (EQ-5D-5L), assessment and postoperative complications of patients who underwent operation were also recorded. Results All 84 patients with an average follow-up of 50.8 (24–105) months. The mean duration of symptoms before treatment was 10.5 months (2–21). There were 27 patients with bony and 57 with primarily soft-tissue involvement based on preoperative evaluation of plain radiographs and MRI. There were 33 patients treated with ATT and 51 patients were treated with surgery followed by ATT. Among them, 13 patients (15.5%) underwent incision and decompression, 14 patients (16.7%) underwent wrist synovectomy, 13 patients (15.5%) underwent wrist joint fusion by plate fixation, and 11 patients (13.1%) underwent wrist joint fusion by external fixation. At the last clinical visit, the QuickDASH, and PRWHE scores of all patients decreased significantly, the VAS improved from 5.9 to 1.4, EQ-5D-5L utility index improved from 0.36 to 0.88, EQ-VAS improved from 40.2 to 89.1. All patients indicated good wrist recovery at the last follow-up, and the treatment achieved satisfactory clinical outcomes. Conclusion The onset of wrist TB is insidious; early diagnosis, good patient compliance, and surgery combined with ATT are crucial steps for treatment of wrist TB, and also essential for the patient's postoperative recovery. Wrist arthrodesis has achieved satisfactory results in the treatment of severe wrist TB.

Pediatric Multidrug-Resistant Disseminated Tuberculosis Presenting as Small Finger Tuberculous Osteomyelitis

“…MRI was obtained during this patient's second hospitalization to screen for subclinical sites of involvement. Inflammatory markers are routinely obtained but often unhelpful because a normal leukocyte count and mild ESR elevation are common [5][6][7][14][15][16]23 . Microbiologic analysis (AFB stain and specimen culture) may be positive in only 10% to 30% of cases 8 .…”

“…Two studies report treatment success with medical therapy alone in 70.5% and 92.8% of pediatric hand TB osteomyelitis cases 5,7 . Larger studies of TB of the hand report a 60.7% to 100% success rate with medical management after biopsy-proven diagnosis 6,14,15,23 .…”

“…Although TB osteomyelitis of the hand routinely requires biopsy for diagnosis, only a minority of patients require operative debridement (and usually only after failed nonoperative management) [5][6][7][14][15][16]23 . Our patient underwent initial I&D for a pyogenic abscess without consideration of TB as a source.…”

Tuberculosis Mimicking-Musculoskeletal Tumor of The Hand: An Uncommon Case of Extrapulmonary Tuberculosis

“…It may also involve antibiotics administration to reduce the incidence of recurrence. 23 Surgical intervention will remove all the infected material and the involved tissues. The local tissue blood circulation will improve after surgery.…”

Tenosynovitis of the Flexor Digitorum and Flexor Carpi Caused by <i>Mycobacterium Tuberculosis</i>: Case Report and Review

“…Инструментальные методы исследований (УЗИ, МРТ) демонстрируют наличие гипертрофированной синовии, увеличение объема сухожилий по сравнению со здоровой стороной, может визуализироваться симптом «рисовых тел», однако представленные данные характерны и для десятков других заболеваний, таких как серонегативный артрит, ревматоидный артрит, системная красная волчанка, онкологические заболевания и др. [3]. Таким образом, клиническая картина заболевания не специфична, что приводит к ошибкам в диагностике и в последующем к неверно выбранной тактике лечения [4].…”