Abstract
Over a four-year period, nine patients with tuberculosis of the wrist were treated. The mean time to diagnosis was 5 months (1 to 20). Restricted wrist motion and an increased sedimentation rate were universal. Swelling, pain on motion and severe restriction of metacarpopha-langeal joint flexion, especially in patients with extensor involvement were common. In three patients, the disease involved the carpal bones, while in five it was limited to the tenosynovium. One patient had a cold abscess not involving tendon, sheath or bone. Granulomatous inflammation on the paraffin section was seen in most patients. Only four had a positive tissue culture of Mycobacterium tuberculosis.
These patients were treated either medially or surgically. In the group treated medically, an incisional biopsy was done and antituberculous chemotherapy administered for a minimum of six months. In the group treated surgically, surgical synovectomy and debridement were done and antituberculous drugs administered. All patients had a brief period of splintage followed by intensive physiotherapy.
At a mean follow-up of 12 months (6 to 24) all patients showed improvement in symptoms, with an increased range of motion. At final follow-up 50% of the patients had some residual loss of wrist motion. Those with extensor involvement seldom regained functional metacarpophalangeal joint flexion. The results showed no recurrence of infection in this study. The treatment resulted in good recovery of function, with low morbidity.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
