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R S Sirohi, a civil engineer, had been suffering from wrist pain for more than a year making his right
hand completely immobile. His wrist pain was finally cured with the help of wrist arthroscopy surgery,
following which a diagnosis was made.
“It all started one evening, when my cell phone rang and I turned around to pick it up from the bed-side table. I felt a sharp pain in my wrist. At first I thought it was a sprain, because of the sudden movement, and waited for it to subside. Even after several weeks, when the pain still persisted; I decided to see a doctor. I am an engineer with the Northern Railways, and responsible for the maintenance of the tracks. The wrist pain made it increasingly difficult to concentrate on any work. I first went to the Railway hospital and despite being given medicines, did not get relief. Thereafter began a long journey: I went to every possible doctor, and every conceivable medical test was done to get some clue about the wrist pain. Even a CT scan of my brain and spine did not reveal the cause of the pain in my wrist! Unable to diagnose the mysterious problem, a doctor gave me steroid injections as a last option, to relieve me of the chronic pain. Unfortunately, even that didn’t work”.
“One doctor told me that my diabetic condition was the reason, and I was put on medications to control diabetes along with pain killers. When the pain persisted, I was put on heavy medication. With each passing day it became more and more difficult for me to move my hand, to the extent that I couldn’t even lift a piece of paper. The pain was terrible and more than a year went by with my right hand almost paralysed.
By this time my family was very worried. There were speculations about my condition. Some even said it might be a rare case of cancer which is why diagnosis was proving difficult. This thought scared me”.
“Finally, I went to AIIMS, where I was suggested synovial biopsy in my wrist, because the doctor suspected an infection. Because of the rush at AIIMS, I went to see another specialist, Dr Vikas Gupta (a hand specialist) at Fortis hospital. Dr Gupta suggested a synovial biopsy after seeing my reports. After the biopsy procedure, when I came to my senses, the mysterious pain had gone. I was later told that I had been suffering from tuberculosis for the past one year, and it was the cause of the chronic wrist pain.
During the biopsy, Dr Gupta had simultaneously cleaned up the infected tissues through a 15- minute surgery, called wrist arthroscopy”.
“However, it came as a total surprise that I had TB in the wrist. I only thought TB affects the lungs. Apparently, TB can affect the bones or spine as well. While TB of lungs is infectious, other forms aren't. I learn’t that when TB bacteria enters a patient’s body, the natural immunity fights off the bacteria, indicated by pus formation. In my case the bacteria persisted, causing me pain. But soon after the surgery, which detected and cleaned up the bacteria infected tissue, followed by medication to cure the remaining TB infection, my pain gradually subsided”.
“I am very grateful to Dr Gupta who was the first to be able to diagnose my problem, and relieve me from the agony I was in.Two months after the surgery, I am almost normal and after months, I am back to work. Looking back, these 15 months have been the most difficult. It was for the first time I was so dependent on my family for everything. As I continue taking two tablets daily, as part of my TB treatment, I already feel fitter and better”.
Dr. Vikas Gupta on the condition and its treatment
“When Sirohi came to me his hand was swollen and he was in severe pain. After going through the various reports, I recommended a synovial biopsy, which helped make a conclusive diagnosis. For the biopsy, we made two incisions in the wrist of his right hand and with the help of a camera, we found tuberculosis infection in his wrist”.
“Then on the operation table itself with the patient under anaesthesia, I cleaned up the infected issues with a procedure called wrist arthroscopy. It is a simple minimally invasive technique. In this procedure, a small camera fixed to the end of a narrow tube is inserted through a small incision in the skin directly into the back of the wrist joint.
The camera lens magnifies and projects the small structures in the wrist onto a television monitor, allowing for a more accurate diagnosis. Several small incisions are used to allow the surgeon to place the camera in different positions to see different structures inside the joint as well as to place various small instruments into the wrist joint to help diagnose and treat various problems”.
“This surgery is particularly helpful for patients suffering from chronic wrist pain for a long period of time, or for those suffering from fracture, arthritis and physical trauma.
Traditionally, such conditions were being treated through an open procedure which doesn’t guarantee 100 per cent mobility in the wrist, and a greater risk of infection.
Sirohi’s pain is almost gone. After the surgery, physiotherapy was required to avoid stiffness in the hand”.
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