161 Isolated tuberculosis of the wrist: elusive but destructive
Bibliographic record
Abstract
Background: Tuberculous arthritis is rare, but can lead to severe complications and disability if untreated. We present a case of tuberculous arthritis of the left wrist, in whom diagnosis was delayed leading to significant joint destruction. Methods: A 36 year old right handed housewife presented with a six month history of left wrist pain following minor trauma. There was no history of systemic symptoms, no relevant past medical or family history and no known tuberculosis (TB) contacts. She was originally from Pakistan but had been in the UK, living in South London, for 15 years. Clinical examination revealed a swollen tender left wrist with limited movement. Systemic examination was unremarkable. Results: She was initially seen in the private sector where routine blood tests, auto immune screen and blood borne virus screen were negative. Bone and synovial biopsy histology showed granulomatous inflammation but was not sent for culture. Initial X-ray wrist was normal and initial MRI showed oedema of the triquetrum. Based on this, a diagnosis of osteonecrosis with complex regional pain syndrome was made. She was then referred to NHS services. Repeat radiographs over four months showed progressive destruction of the carpal bones and MRI revealed severe extensive synovial thickening with secondary diffuse bony oedema.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".