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#ItsTime My first case on Tubeculosis day #itsTime A 53 y/o male presented with left side isolated hand swelling for a 7-month duration. Its progressive enlargement was associated with pain and restriction of movements. On examination, there was a swelling near the wrist joint and carpal region both volar and dorsal aspects. The area was not warm, and mild tenderness was elicited. Flexion extension and circumduction movements were reduced. Distal neurovascular examination was unremarkable. What this x-ray shows?

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SUGGESTIVE OF PERI ARTICULAR OSTEOPOROSIS SYNOVITIS POSSIBLY TUBERCULAR NEEDS. FURTHER EVALUATION
Groos bonny destruction of carpal bones swelling may be due to synovitis with effusion As unilateral side involve not suggestive of systemic disorder like rheumatoid is unlikely may may be taken up as tuberculosisi but it must be clinically established before starting ATT Complete blood test with RSR CRP .MT. Xrat chest CT may be helpful In no conclusion possible then only left with biopsy and HPE.
Xray show bone destruction in carpal bones Periarticular osteoporosis Swelling due to synovitis and effusion Unilateral involvement favour TB than RA Still confirmation needed before ATT CT evaluation will help CBC esr Mantaux test Chest xray Open biopsy is the final solution to confirm,if other tests are not conclusive
Erosion of Carpal & bases of meta carpal bones. ? TB / OA Investigations required to r/o & reach at final diagnosis
* TUBERCULAR PERI ARTICULAR SYNOVITIS NEEDS FURTHER INVESTIGATION AND EVALUATION TO CONCLUDE AND TREATMENT PLAN.
Thanks Dr Dinesh Gupta
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Errasive lesions scaphoid almost lost with swelling Cold abscess tubercular
Thanx dr Ashok Leel
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Osteoporosis Destruction of carpal bones
Osteoarthritis, Tubercular arthritis
Degenerative changes carpel bones
?Osteoarthritis
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