Wrist joint tuberculosis

　　Tuberculosis bacteria generally cannot directly invade the wrist joint and joint, therefore, a large part of wrist joint tuberculosis lesions are secondary, about 95% secondary to pulmonary lesions. Tuberculosis bacteria enter the blood through the lymph nodes, and then spread throughout the body. Due to the large amount of wrist joint movement, when the physical condition declines, malnutrition, chronic fatigue, or cumulative injury, it promotes the formation of tuberculosis lesions.

　　The wrist joint structure is complex, with the proximal part being the radius and ulna, the distal end of the wrist joint and the triquetrum soft wrist joint, the middle being 8 wrist wrist joints, and the distal end being the base of the metacarpal wrist joint. The characteristics of the wrist wrist joint are many articular surfaces, poor blood supply, no muscle coverage around the wrist joint, only many tendons, nerves, and blood vessels passing through, so wrist joint swelling is easy to be detected, abscesses are prone to break down and form sinus tracts. In addition, abscesses occasionally penetrate the synovial sheath, causing secondary synovial tuberculosis. The synovium of the wrist joint is less, while the cancellous component is more, so in wrist joint tuberculosis, simple wrist joint tuberculosis or total joint tuberculosis originating from wrist joint tuberculosis accounts for the majority.

　　In wrist tuberculosis, simple synovial tuberculosis and simple wrist joint tuberculosis are rare. This is because the synovium of the wrist is less, the incidence of synovial tuberculosis is low, and the volume of the wrist wrist joint and palmar wrist joint bases is small, and the amount of the wrist joint is not much. The lesions often quickly invade adjacent joints and become complete joint tuberculosis. Only the lower part of the radius and ulna wrist joints has a larger volume and can still be seen with simple wrist joint tuberculosis.

　　In the early stage, wrist joint swelling can be seen in patients with wrist tuberculosis, which can lead to changes in bone and joint effusion. In the late stage, sinus tract formation may also occur, leading to deformity due to pathological dislocation or subluxation. In severe cases, the wrist joint may become rigid.

　　The pain of wrist joint patients is mild at the beginning of the disease, and it gradually intensifies as the lesion progresses. When the lesion develops from simple synovitis or wrist joint tuberculosis to complete joint tuberculosis, the pain is very obvious. The tenderness of simple wrist joint tuberculosis is limited to the site of the wrist joint focus, while that of synovial tuberculosis and complete joint tuberculosis is around the entire joint. Due to the rarity of soft tissue around the wrist joint, swelling is easily discovered, especially on the dorsal side. The fingers, due to reduced activity, have obstructed venous return and often have mild edema.

　　The functional impairment of simple wrist joint tuberculosis is mild, while that of complete joint tuberculosis is more obvious. If the ulnar and radial joints are involved, the function of forearm rotation is restricted. In severe cases of wrist joint destruction, due to the long-term inactivity of the fingers, they become stiff. If the extensor tendons of the fingers are destroyed or adhesions occur, the function of the fingers is significantly restricted.

　　Abscesses are often located on the dorsal or palmar side of the wrist, which can be felt as fluctuation. After the abscess ruptures, sinus tracts form, and initially, there is only one sinus tract. After mixed infection occurs, the sinus tracts can become multiple, and the closure of sinus tracts forms scars. Common deformities include pronation of the forearm, wrist drop, and deviation of the hand towards the ulnar or radial side.

　　Active treatment of tuberculosis, prevention of the spread of tuberculosis, and active prevention of recurrence after surgery are the key to the prevention and treatment of wrist tuberculosis. In addition, it is necessary to prevent recurrence actively after surgery. In principle, on the basis of thoroughly removing the focus, standardized and adequate combined chemotherapy should be carried out for a period of not less than 1 to 1.5 years. For patients with poor joint stability and excessive removal of the diseased wrist joint, joint fusion surgery should be performed to limit joint movement, and nutrition should be strengthened, physical fitness improved, and the body's resistance enhanced to avoid overwork and excessive burdening.

　　Patients with wrist tuberculosis can also eat more seafood, such as nori, deep-sea fish, and shrimps. The nutritional value of marine life is very high, with functions of kidney-reinforcing and Yang-tonifying, nourishing Yin and strengthening the wrist joint, and calming, which can be used to treat various diseases such as tetany of hands and feet, skin ulcers, chickenpox, pain in the wrist joint, and wrist tuberculosis.

　　

　　The location of wrist joint destruction in patients with the disease is most common at the radius-ulna joint, the capitate wrist joint, and the hamate wrist joint. In later cases, the joint structure is completely destroyed, and wrist wrist joint fusion between wrist joints is not uncommon, but it is rarely seen that the radius-ulna joint fuses with the wrist joint. The examination mainly includes the following several items:

　　1. Some patients may have an increased erythrocyte sedimentation rate.

　　2. X-ray examination shows wrist joint osteoporosis and soft tissue swelling in early cases. When it develops into full joint tuberculosis, there is progressive narrowing of the wrist joint space and the radiocarpal joint space, as well as marginal wrist joint corrosion.

　　3. CT examination can show marginal wrist joint destruction early, and can also detect dead wrist joint.

　　4. MRI examination can detect joint effusion and abnormal inflammatory infiltration signals in the wrist joint early.

　　5. Arthroscopic examination: Arthroscopic examination can help diagnose wrist synovial tuberculosis by taking synovial tissue for histopathological examination.

　　Wrist joint tuberculosis patients should eat more marine products such as seaweed, deep-sea fish, and shrimps. The nutritional value of marine organisms is very high, with functions such as kidney and Yang tonification, nourishing Yin and strengthening the wrist joint, and calming, which can be used to treat various diseases such as tetany, skin ulcers, chickenpox, pain in the wrist joint, and wrist joint tuberculosis.

　　Wrist joint tuberculosis belongs to a type of bone and joint tuberculosis. Currently, the chemotherapy regimen for bone and joint tuberculosis can be divided into standardized short-course chemotherapy and ultra-short-course chemotherapy according to the length of the course, but there is no unified definition of the duration of the course. In clinical practice, regardless of which chemotherapy regimen is adopted, the toxic and side effects of drugs need to be strictly monitored during treatment, and timely treatment should be given.

　　After the introduction of anti-tuberculosis drugs, through many years of clinical application and efficacy observation and research, a standardized therapeutic regimen for bone and joint tuberculosis has gradually formed. That is, isoniazid 300mg + rifampin 450mg + ethambutol 750mg + streptomycin 750mg combined medication, intensive treatment for 3 months and then stop using streptomycin; continue to use isoniazid + rifampin + ethambutol for 9-15 months, total course of treatment 12-18 months. The standard therapeutic regimen is mainly used for the following situations:

　　1. Sensitive to first-line drugs such as isoniazid and rifampin.

　　2. Cases with partial recurrence, non-healing, relapse after treatment, and failure of surgery.

　　3. Cases with extensive lesions, where dead bone and sinus tracts cannot be completely removed.