Shoulder tuberculous arthropathy

Case contributed by Dr Maulik S Patel

Presentation

Right shoulder diffuse swelling, restricted movements for last 1 month. History of right anterior axillary pus drainage a few months back.

Patient Data

Age: 60 years
Gender: Female
X-ray

There is an erosion of humeral head articular surface. Acromion-humeral distance is increased. There is increased soft tissue density in the deltoid region. There is no fracture/ dislocation.

Ultrasound

There is moderate to gross synovial hypertrophy with effusion and mobile echoes involving glenohumeral joint as well as subacromial-subdeltoid bursa. There is full thickness, a full-width defect involving the supraspinatus tendon with retraction about 28 mm. Long head biceps, subscapularis and infraspinatus tendons are intact. There are multiple erosions involving articular surface of the humeral head. Supraspinatus and infraspinatus muscles show mild to moderate fatty infiltration as well as atrophy. There are multiple axillary nodes with loss of hilar fat and with peri-adenitis.

Case Discussion

An elderly female presented with a history of treatment taken for pus discharge from the anterior aspect of the right shoulder a few months back. She developed right shoulder region diffuse swelling and restricted right shoulder movements for last 1 month. Radiograph and ultrasound favor glenohumeral osteomyelitis; possibly tuberculous etiology. Open biopsy and synovectomy were done. Histopathology revealed tuberculosis.

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Case information

rID: 59204
Published: 28th Mar 2018
Last edited: 29th Mar 2018
Inclusion in quiz mode: Included

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