A prospective Study on Wrist Tuberculosis: Challenges in Diagnosis and Management

Introduction: Wrist Joint is an uncommon site for tubercular infection. However, it is more commonly seen in south-east Asia than in developed parts of the world. The diagnosis is often delayed, because of its rarity and hence many patients have to live with long term sequale of stiffness and pain.

Materials and Methods: Twenty-two (22) patients presenting with wrist joint tuberculosis between January 2013 and January 2018 were treated with antitubercular drugs, splinting and were prospectively followed up for a minimum of 18 months duration. The evaluation of outcome was based on Patient Rated Wrist Evaluation.

Result: Seventeen (17) patients had microbiological or histopathological confirmation of diagnosis. Five (5) patients with high clinical suspicion and negative diagnostic workup were also treated for tubercular arthritis. Mean Patient Rated Wrist Evaluation improved from 115 at the beginning to 31 at 18 months.

Conclusion: It is important to avoid delay in the diagnosis of wrist tuberculosis. Whenever the clinical suspicion is high and diagnostic workup is negative, a therapeutic trial of anti-tubercular drugs could be option to escape and manage this havoc early. Chemotherapy with combination of anti-tubercular drugs is safe and effective in treatment of wrist tuberculosis.