Diagnostic Challenges of Wrist Tuberculosis: A Systematic Review

Abstract Wrist tuberculosis (TB) is a rare manifestation of osteoarticular TB that presents substantial diagnostic challenges, particularly in TB-endemic regions. Its insidious onset and nonspecific clinical manifestations frequently lead to misdiagnosis and delayed treatment. This systematic review aimed to synthesize the available evidence regarding the diagnostic challenges associated with wrist TB. A systematic literature search was conducted in PubMed/MEDLINE, EMBASE, Scopus, and Web of Science from database inception to January 2026. Observational studies reporting wrist-specific diagnostic findings in suspected or confirmed wrist TB were included. Case reports and case series were excluded from the evidence synthesis but considered for contextual discussion. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in study design and outcome reporting, a qualitative narrative synthesis was performed. Four observational studies conducted in TB-endemic regions met the inclusion criteria. Patients commonly presented with chronic wrist pain, swelling, and limited range of motion, symptoms that frequently mimicked other musculoskeletal conditions and contributed to delayed clinical suspicion. Plain radiography was typically used as the initial imaging modality, but often demonstrated nonspecific findings. Magnetic resonance imaging improved the detection of synovial inflammation and bone involvement but lacked sufficient specificity to confirm the diagnosis. Microbiological tests, including smear microscopy, culture, and polymerase chain reaction, showed limited sensitivity because osteoarticular TB is typically paucibacillary. Histopathological examination of biopsy specimens demonstrating granulomatous inflammation remained the most reliable diagnostic method. Wrist TB remains difficult to diagnose due to nonspecific clinical presentation and limitations of conventional diagnostic tests. Histopathological confirmation continues to represent the diagnostic standard. Increasing clinical awareness and improving diagnostic pathways may help reduce diagnostic delay and prevent irreversible joint damage.