Abscess or sinus tract on the dorsal or volar wrist

Introduction The abscess or sinus of the dorsal or volar side of the wrist is a clinical manifestation of carotid tuberculosis. The intestine is characterized by an abscess or sinus. The abscess is often located on the dorsal or volar side of the wrist and can be fluctuated. The sinus is formed after the abscess is broken, and the initial sinus is one. After the mixed infection occurs, the sinus can be changed into multiple, and the sinus can be closed to form a scar. Active treatment of tuberculosis and prevention of the spread of tuberculosis is the key to the prevention and treatment of this disease.

Cause

Causes of abscess or sinus on the dorsal or volar side of the wrist:

(1) Causes of the disease: Mycobacterium tuberculosis generally cannot directly invade bones and joints, so a large part of bone and joint tuberculosis lesions are secondary, about 95% secondary to lung lesions, tubercle bacilli enter the blood through lymph nodes, and then spread to whole body. Due to the large amount of activity of the wrist joint, the formation of tuberculosis is promoted when the constitution is declining, malnutrition, chronic strain or cumulative damage.

(B) the pathogenesis: the wrist joint structure is complex, the proximal end is the iliac crest, the lower end of the ulna and the triangular cartilage, the middle is 8 carpal bones, the distal end is the metacarpal base. The characteristics of the wrist bone are more joint surface, poor blood supply, no muscle coverage around the wrist joint, only a lot of tendons, nerves and blood vessels pass, so the swelling of the wrist joint is easy to be found, and the abscess is easy to collapse to form the sinus. In addition, the abscess occasionally penetrates the tendon sheath, causing secondary tendon sheath tuberculosis. There are fewer synovial membranes in the wrist, and there are many components of the cancellous bone. Therefore, in the joints of the wrist joints, the majority of the tuberculosis or the total joint tuberculosis from the bone tuberculosis should be the majority.

Among the wrist tuberculosis, simple synovial tuberculosis and simple bone tuberculosis are rare. This is because there are fewer synovial membranes in the wrist and the incidence of synovial tuberculosis is low. The volume of the carpal bone and metacarpal base is very small, and the bone mass is not much. The lesion often invades the adjacent joint and becomes the whole joint tuberculosis. Only the lower end of the ankle and ulna is larger, and only simple bone tuberculosis can be seen.

The lesions are classified into a central type and an edge type, and have various types of characteristics. These features are easier to see at the lower end of the ankle and ulna. In the base of the carpal and metacarpal, due to the small size, the central and marginal types are not easily distinguished, and often develop into full-tubular tuberculosis.

Among the bones constituting the wrist joint, the incidence of the lower end of the humerus, the skull and the hook bone is the highest, followed by the large and small polygonal bones, and the triangular and metacarpal bases are the least. Pea bone tuberculosis is extremely rare. In the advanced stage of the lesion, the forearm pronation, wrist drooping, and ulnar deformity gradually occurred, and the joints gradually became stiff. The iliac crest and the lower end of the ulna occupy an important position in the development of the ulna and ulna. Therefore, if the child's lower end of the humerus is destroyed by tuberculosis, the tibia will be shortened in the future, resulting in a wrist deformity.

an examination

Related inspection

Joint examination of bone and joint soft tissue CT

Diagnosis and examination of abscess or sinus on the dorsal or volar side of the wrist:

[clinical manifestations]

1. The pain is mild at the beginning of pain and tenderness. As the lesion develops, the pain gradually worsens. When the lesion develops from simple synovial membrane or bone tuberculosis to total joint tuberculosis, the pain is obvious. Simple bone tuberculosis is limited to the location of the bone lesion, and synovial tuberculosis and total joint tuberculosis have tenderness around the joint.

2. Swelling Because there is little soft tissue around the wrist, swelling is easy to find, especially on the dorsal side. Due to decreased activity of the fingers, venous return is blocked, often with mild edema.

3. Dysfunction The dysfunction of simple bone tuberculosis is light, and the total joint tuberculosis is more obvious. If the ankle joint is involved as follows, the forearm rotation function is limited. If the wrist is severely damaged, the fingers are stiff and the fingers are stiff. If the tendons are broken or the adhesions occur, the function of the fingers is obviously limited.

4. Abscess or sinus abscess is often located on the dorsal or volar side of the wrist and can be fluctuating. The sinus is formed after the abscess is broken, and the initial sinus is one. After the mixed infection occurs, the sinus can be changed into multiple, and the sinus can be closed to form a scar.

5. Malformation common forearm pronation, wrist drooping and hand deviation or deviation.

diagnosis

According to the symptoms, signs, X-ray examination, the diagnosis is not difficult. X-ray films of simple synovial tuberculosis only showed soft tissue swelling and local osteoporosis. X-ray films of tuberculosis at the lower end of the ulna and radius can be divided into central type and marginal type. The former often has dead bone formation, and the dead bone absorbs to form a cavity; while the latter often sees bone destruction. Although the carotid and metacarpal tuberculosis has a central type and a marginal type, it is easy to invade the joint surface and become a total joint tuberculosis, which is characterized by sparse carpal bone. Early total joint tuberculosis is still seen in the marginal destruction of joints. In the late stage, several carpal bones were clearly damaged, and blood flow was blocked, forming a dead bone. At the beginning, the joint space is enlarged and becomes narrower or disappears later. Because the positive appearance of X-ray examination appears later, CT or MRI should be performed early on cases with symptoms, signs and blood cell sedimentation rate. For suspected cases, experimental anti-tuberculosis treatment and plaster support should be fixed for 2 months. Patients responded well to treatment and should be treated with wrist tuberculosis and followed closely.

Differential diagnosis

The abscess or sinus of the dorsal or volar side of the wrist needs to be identified with the following diseases:

1. Rheumatoid arthritis The wrist joint is a good site for rheumatoid arthritis. It can show osteoporosis, small cystic defect at the edge of the joint, narrowing of the joint space, pathological subluxation, or bony rigidity, but it often involves multiple joints symmetrically, with intermittent symptoms, erosion of the bone surface or small capsules. Absorption, no abscess, sinus or dead bone formation. The patient is often a woman of about 40 years old, mostly bilateral, often with other joint lesions. Single hair is not easy to distinguish from synovial tuberculosis. Diagnosis must be based on biopsy and bacteriological examination.

2. Monthly osteonecrosis is more common in young adults, and patients are often manual workers. The main complaint is chronic swelling and pain in the wrist, and there is a history of trauma. At the beginning of the X-ray film, the lunate bone is relatively dense, and the lunate bone is flat and the edges are not neat. The patient's erythrocyte sedimentation rate is not fast, and other wrist bones are normal.

3. Brodie bone abscess The Brodie bone abscess can be seen at the lower end of the tibia. X-ray films showed limited osteolytic destruction at the lower end of the humerus. Generally, there was no dead bone and the bone wall was slightly hardened. It is often difficult to distinguish from central bone tuberculosis. Surgery, bacterial culture and pathological examination are required.

4. The tendon sheath of the tendon sheath is swollen with gourd shape and the finger function is limited. The main point of identification is that the X-ray film is negative, and the swelling and tenderness are limited to the side of the wrist or palm.

5. Wrist tumor The lower end of the tibia is the predilection site of the primary bone tumor. It can be seen in giant cell tumor and reticulocyte sarcoma. When the tumor is small, it needs to be differentiated from the bone cavity of the central tuberculosis. The former is osteolytic destruction. The latter wall is reactive and dense.

6. Sudeck's bone atrophy: similar to the early X-ray findings of wrist joint tuberculosis. The former mainly involves the cancellous bone, which is the phenomenon of most speckled bone absorption. The cortex is smooth and not damaged, and the joint space is unchanged.

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