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TUBERCULOSIS OFBONES & JOINTS

By: Yik

Group 29

Faculty o

Tuberculous Arthritis

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Possible Pathology

Joint

Arthritis TB

Synovial TB

Others TB Tenosynovitis

TB Bursitis

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General View in TB of Bones and Joint

TB Bones & Joints always secondary to some primary focus in lungs,lymph nodes, etc.

Mode of Spreading : -Haematogenous dissemination-Direct neighboring focus

Most frequently affect children, adolescent

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Risk Group

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Tuberculous Arthritis /Arthropathy

The most common form of articular tuberculosis is

spondylitis followed by arthritis of weight bearingjoints (especially knee and hip). The spine is themost common site followed by the hip joint whichconstitutes approximately 15% of all cases.

Tubercular arthropathy can affect any joint but

frequently reported in knee, ankle, sacroiliac joint,sternaoclavicular joint, shoulder, elbow and wrist.

Tubercular arthropathy is usually monoarticular.

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Clinical Picture

Decreased movement in the joints

Excessive sweating, especially at night

Joint swelling with warm, tender joints

Low-grade fever

Muscle atrophy

Muscle spasms

Numbness, tingling, or weakness below the infection (if the spine is involv

Weight loss or loss of appetite

Note: The condition usually starts slowly and usually involves only one joint.

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Physical Findings

Hip Joint Lesion

Gait Lameness

Muscle wasting ( Thigh, gluteal )

Swelling around hip

Discharging sinuses Deformities

One-shortening of limb length

Muscle spasm

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Radiological Findings

PhimstersTriad

Reduction of Joint Space

Erosion of articular surface

Peri-Articular Osteoporosis

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On the basis of radiological features tubercular arthropathy can be devid

Early stages (stage of synovitis and arthritis) - radiographic features inclu periarticular demineralisation

joint space widening (due to joint effusion)

mild subchondral erosion

Late stages (stage of erosion and destruction) gradual narrowing of joint space (there is involvement of articular ca

severe subchondral erosion and destruction

pathological subluxation and dislocation fibrous ankylosis - in contrast to pyogenic arthritis, the development

ankylosis is uncommon in tuberculous arthritis and, when present, islikely to be secondary to prior surgical intervention

atrophic changes in bones may occur and lead to atrophic arthropatin shoulder joint as carries sicca)

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TB of the Hip

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Lesion in left sacro-iliac joint

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Lesion in right gleno-humeral joint

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Other Investigations:

Blood Analysis : Lymphocytic leukocytosis, High ESR

Mantoux Test : Postive

Synovial Fluid Aspiration : Low Viscosity, Yellowish, translucent, Increasedecrease glucose level, Positive Culture

*Additional diagnosis: CT, MRI, Biopsy

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Treatment

Standard Anti-Tuberculosis Chemotherapy + conservative skin traction

*If present severe joint destruction:

>Operative treatment:

1)Joint debridement

2)Arthoplasty

3)Arthrodesis

4) Synovectomy

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Joint Debridement

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Athroplasty

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Arthrodesis

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Thank you for your attention.