Tubercular arthritis - shoulder

Case contributed by Dr Amit Mishra

Presentation

Long-standing history of decreased range of movements, pain and swelling.

Patient Data

Age: 50 years
Gender: Male

Bony erosions are noted in the humeral head and glenoid margins. There is full-thickness cartilage loss involving glenohumeral joint with markedly reduced joint space. There is mild posterior subluxation of the humeral head. Edema is seen in rotator cuff muscles.

Bursal fluid collections are noted around the shoulder joint involving subdeltoid and subcoracoid bursae. Bursal collections are seen to displace the glenoid labrum, deltoid and long head of biceps tendons. There is mild to moderate glenohumeral joint effusion with gross capsular thickening. Post-contrast study shows rim enhancement of the bursal collection and thick enhancing glenohumeral joint capsule. 

Case Discussion

Tuberculosis of the joints is a form of chronic illness which progresses through synovitis and joint effusion and gradually leading to articular cartilage loss, erosions of bony margins involving the joint and finally gross distortion of the joint with bony subluxations and dislocations.

Tubercular arthritis of the shoulder can present with cold abscesses and sinus tract formation which is more common in children while the dry form(also known as caries sicca) is common in adults in which there is bony erosions, articular cartilage loss, capsular thickening/contracture and subluxation/dislocation without pus formation.

In this case, there is gross bursitis and capsulitis as well as marked bony erosions and advanced arthritis changes.

A bursal aspirate was obtained which showed the presence of granulomatous cells.

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