Is a wrist swelling in a osteoporotic female tuberculosis?

Question

Hello doctor,

My mother who is 67 years old is an osteoporosis patient. She has been recently operated for carpal tunnel in the left hand. A few months back, she had developed an ankle effusion which subsided after starting osteoporosis injections. She is on Gemtide and Calcium. Recently, she has developed swelling in the right wrist with pain and stiffness. She had an ultrasound and an X-ray as advised by her doctor. The ultrasound report is attached herewith. The X-ray suggests osteopenia. Does the ultrasound report suggest she has tuberculosis? Please advise as to what should be done.

Answer 1

Hello,

Welcome to icliniq.com.

I went through your attachments (attachment removed to protect patient identity). An ultrasound cannot diagnose whether she has tuberculosis or not. This requires an MRI (magnetic resonance imaging) scan and also a needle biopsy under ultrasound guidance which needs histopathologic examination. A thickened synovium can be an infection or just an inflammation that cannot be differentiated by ultrasound alone. Injection Gemtide (Teriparatide) is good for her osteoporosis and is a correct drug. I suggest you get an MRI scan done first and upload the reports and then we will decide whether a needle biopsy is needed or not. This professional advice provided by me stands subject to the actual examination of the report and image and is based entirely on inputs provided to me. It should be correlated with clinical findings.

Thank you.