Wrist Joint Tuberculosis

Wrist TB ranks third among upper limb joints at 0.43 per 100 osteoarticular TB patients, mostly in adults. As with other limb joints, patients often have TB elsewhere.

Common Symptoms

Yan Tie; osteoporosis; bone pain; wrist spur; sequestrum; night sweats; wrist drop; low fever; soft tissue swelling; dorsal or palmar wrist...

Causes and Pathogenesis

(1) Etiology: Bacilli cannot directly invade bone/joints, so ~95% are secondary to pulmonary lesions; bacilli enter blood via lymphatics and spread systemically. High wrist mobility plus declining constitution, malnutrition, or chronic strain promotes lesions. (2) Pathogenesis: The wrist is complex, with distal radius/ulna and triangular cartilage proximally, 8 carpal bones, and metacarpal bases distally. Carpal bones have many articular surfaces and poor blood supply; no muscles cover the wrist, only tendons, nerves, and vessels, so swelling is easily seen and abscesses readily rupture into sinuses; abscesses occasionally penetrate tendon sheaths causing secondary tenosynovitis. Wrist synovium is scant and cancellous bone abundant, so simple osseous TB or secondary total joint TB predominates. Simple synovial and osseous TB are both rare due to scant synovium and small carpal/metacarpal size that quickly involve adjacent joints; only the larger distal radius/ulna show simple osseous TB. Lesions are central or marginal; at small carpal bones they quickly become total. Among carpal bones, distal radius, capitate, and hamate are most affected, then trapezoid/trapezium, then triquetrum/metacarpal bases; pisiform TB is extremely rare. Late lesions show forearm pronation, wrist drop, ulnar deviation, and progressive ankylosis. If the distal radial epiphyseal plate is destroyed in children, the radius shortens with radial deviation.

Treatment

Supportive therapy, rehabilitation, surgical treatment

Preventive Measures

Treating TB and preventing spread is key. Postoperative recurrence prevention requires thorough debridement followed by standardized, adequate combination chemotherapy for at least 1-1.5 years. Unstable joints with extensive debridement may require arthrodesis. Strengthen nutrition and avoid overwork or early weight-bearing.

Department to Visit

It is recommended to visit the Orthopedic Surgery department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.