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Do I have tuberculosis in my wrist?

Q: I am a 21 years old man having pain in my right wrist for the last three years. There is pain and the motion of the wrist is restricted too. I cannot use my wrist fully. The MRI report stated that there is fluid collection in scaphoid and triquetral joint, sign of synovitis. What does it mean? The doctor suggested biopsy and fine needle aspiration cytology (FNAC) test. Are these tests necessary? Is there tuberculosis in my wrist? I have qualified for the combined defence services and there is SSB interview and medical examination after 30 days. I had plaster for a month and now I have tied crepe bandage for the last many days. What should I do as my whole career is dependent on it?

A:You are faced with two problems; one is that you are concerned about what is the problem with your wrist. Number two, you are concerned about your future placement in the Defence services.

First of all, you have had your symptoms for three years. It is unlikely that tuberculosis of the joint will remain for three years without presenting as tubercular pus or tubercular discharge or marked deterioration of the joint without treatment. The way you have described your symptoms and the MRI findings it seem to be some type of arthritis particularly if the doctor feels there is an evidence of synovitis and the restriction of joint movements. Synovitis is a term used to indicate that there is swelling in the lining of the joint. The lining of the joint is called synovium and when that is inflamed you call it synovitis. You may recognise this term itis from other commonly used terms like inflammation of tonsils is called tonsillitis, inflammation of the conjunctiva of the eye is called conjunctivitis. Your problem can be part of an arthritis are also sometimes there are changes in the blood supplies to the bones of the wrist (called carpal bones). However, this can be easily made out on MRI.

You could get an FNAC done to have a better tissue diagnosis. However, in most cases of arthritis the changes that are seen on such a biopsy are likely to be non-specific. The only time it will be confirmatory is when there is an infection like tuberculosis or when there is a tumour (cancer). With your prolonged history both these are unlikely.

Therefore, before you get an FNAC please get all the tests of blood, which are normally done to exclude an arthritic condition. This may give a clue to your diagnosis. You could also get an X-ray repeated and find out changes that have occurred over the past three years.

Now, coming to your concern about fitness in the combined Defence services, if your condition is not obvious clinically you may get away with it without anyone noticing. But if you do have restriction of movement of the wrist the medical officer will pick it up and you will be declared unfit. As long as they are convinced about an arthritic condition with the restriction of wrist movement you will be declared unfit. There is no way that this can be hidden. If the medical officer is kind he may ask for a review after treatment of the condition. But if the X-ray shows changes of arthritis you will be declared unfit. Obviously then you will have to look for alternatives other than Defence jobs. While it is creditable that you are patriotic enough to want to serve the country through its defence services it is also important the defence services have officers that are fighting fit. Therefore, in all fairness to your desire and the rules of the defence services it is better that in such a situation you look for alternative jobs. May be in the long run that is best for you. Who knows about tomorrow?

Meanwhile, get to a competent orthopaedic surgeon and have your problem sorted out.

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