Anyone know anything about tuberculosis of the wrist?

  1. I was doing my pre-lab for clinicals and the patient I was assigned had tuberculosis of her wrist when she was younger and was treated for it. Working as a CNA (and to make a long story short) I had a TB scare and needed to go for a chest x-ray (which was negative whew). Anyways I was wondering what that is exactly. Is it just located in her wrist? I noticed she wasn't in isolation and even had a roommate so I'm guessing it's not contagious? I couldn't find that much info on it.

    Thanks,
    Wendy (aka the worried nursing student lol)
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  2. 8 Comments

  3. by   TJNurse
    TB affects the lungs, maybe you mean arthritis? To be tested for TB you are injected in your forearm, if it comes back positive (raised wheel > 10mm) you then need a chest x-ray...followed by possible treatment, usually isoniazid (INH)

    Here is some information for you that might be helpful:

    http://www.cdc.gov/nchstp/tb/faqs/qa.htm
  4. by   2ndCareerRN
    TB is not limited to the lungs. There are several types of extrapulmonary TB.

    TUBERCULOSIS OF BONES AND JOINTS
    When primary TB occurs in children while the epiphyses are open and the blood supply to bone ends is rich, bacilli often disseminate to the vertebrae and ends of the long bones. Disease may develop quickly or months, years, or decades later. Infection may spread into the articular capsule, causing a monarticular arthritis. Weight-bearing joints are commonly involved, but bones of the wrist, hand, and elbow also may be involved, especially after injury.

    Pott's disease begins in the vertebral body next to the disk space. Characteristically, two vertebrae are involved and the disk space between them is narrowed by caseation. (This differs from metastatic carcinoma, which involves the vertebrae without narrowing the disk space.) If the disease is not diagnosed and treated promptly, the vertebrae may collapse, resulting in paraplegia. Infection is best detected early by MRI, since deformity may not be detectable on spinal x-rays taken early in the illness. If diagnosis cannot be made and symptoms of localized back pain persist or worsen, studies should be repeated. A paravertebral swelling at the involved site may represent an abscess, which, if neglected, may dissect down the psoas muscle and point on the anterior aspect of the thigh.

    Diagnosis may be suspected from symptoms, but CT or MRI is essential. Diagnosis is best confirmed by biopsy; in the spine, bone may be sampled by needle biopsy. At other sites, a biopsy of synovial tissue or bone is necessary. The tissue specimen should be examined histologically and stained for M. tuberculosis, fungi, and other pathogens. It should also be studied by PCR and cultured for TB and other pathogens (eg, Staphylococcus, Brucella, Salmonella, Francisella tularensis).

    Chemotherapy usually suffices if vertebral destruction is limited and the cord is not pinched. If the swelling beside the vertebrae subsides with therapy, it probably is not an abscess and will not need debridement. However, the involved area should be immobilized with a well-fitted brace during chemotherapy. If the swelling does not subside or pain persists, surgical debridement may be necessary. Only the most advanced cases require fixation of the vertebral column by anterior or posterior bone graft.
    http://www.merck.com/mrkshared/mmanu...er157/157g.jsp

    TB of the joints is often overlooked because it is not a common diagnosis.

    bob
  5. by   sbic56
    http://www.intelihealth.com/IH/ihtIH...339/10604.html

    http://www.gobroomecounty.com/safety/HaSTBIndex.php

    Good question! I wasn't familiar with TB of the bones, but according to these links, it makes up 8% of TB cases. Looks like only the pulmonary TB is contagious, at least as far as that second link implies. Not a ton out there on it that I could find, really. Hope these links help. Thanks for helping me to learn something new today!
  6. by   prmenrs
    The above 2 posters are correct.

    And it is definitely not contagious!
  7. by   Morning-glory
    My mother had TB as a teenager. She was treated but still has scars on her lungs from it. I test negative, but my brother and sister test positive even though, after much testing, they have no sign of TB. My brother was given chemo for a year. What a nightmare that was. Loss of short term memory, like forgetting how to take a shower and he couldn't drive because he would forget how to get home, etc...

    I took a course on TB, and even the specialist there couldn't explain to me why I was still negative. Just too wierd.

    Jacquie
  8. by   PicklesRN
    Quote from NurseWendy
    I was doing my pre-lab for clinicals and the patient I was assigned had tuberculosis of her wrist when she was younger and was treated for it. Working as a CNA (and to make a long story short) I had a TB scare and needed to go for a chest x-ray (which was negative whew). Anyways I was wondering what that is exactly. Is it just located in her wrist? I noticed she wasn't in isolation and even had a roommate so I'm guessing it's not contagious? I couldn't find that much info on it.

    Thanks,
    Wendy (aka the worried nursing student lol)
    I had a care home patient once that had TB in his spine. I've been sitting here trying to remember the details and for the life of me I can't remember much.

    I recall he had some type of surgery (done many years before I met him) where he described attaching a metal rod along his spine. On film it looked like a pole next to his spine attached by twist ties. You know, the twisty thing on your bread wrapper? It wasn't *really* like that but it did kinda look like that. Looked like they used twisties holding his spine with this rod.

    One of the 'twisties' broke and you could very easily feel with your hand the metal rod and his spine and the 10-12mm of space between the two. It was ... bizarre? Hard to describe it.

    He's the only patient I recall having that had TB of something other than the lung.
  9. by   KRVRN
    Only pulmonary and laryngeal TB are contagious.
  10. by   Wen83
    Thanks everyone for your posts, they were all so helpful... especially since no one I talked to today knew anything about it!

    -Wendy

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