BRIEF

REPORTS

523

TUBERCULOSIS A REPORT OF

OF

THE FIVE

ELBOW: CASES

R. W. PARKINSON,

S. P. HODGSON,

J. NOBLE

Tuberculosis including features

two

of the elbow is rare. We of olecranon bursitis. in Table I and

report The amplified

five cases, important below.

significantly with systemic graphs patients

raised in only one symptoms. Only

(case 5), the sole one of the elbow and none None

patient radioof the of our

are summarised

Discussion. Tuberculosis of the and has been only sporadically reported in our series are drawn Greater 1987. Manchester areas

elbow is rare in the UK reported. The five cases from the Blackburn and the years 1979 to

showed any bony abnormality had abnormal chest radiographs.

between

patients had a previous history of tuberculosis. tests were not performed, though we recognise might have been helpful (Newton, Sharp 1982).

Mantoux that these and Barnes

Table

I. Case

summaries Case I Case 42 Caucasian 4 2 Case 29 Asian 1 3 Case 30 Asian 2 4 Case 5 32 Asian 2

Age Race Lengthof history (mth) Diagnosis

suspected at

72 Caucasian 6

No

No

Yes

Yes

Yes

presentation Interval between presentation and diagnosis

Pattern of

26 months

I week

3 weeks

None

None

Synovitis

Olecranon

Olecranon

Synovitis,

Synovitis

involvement

bursitis

bursitis

olecranon osteitis Biopsy, curettage Aspiration

Surgical treatment

Synovectomy

Olecranon bursectomy

Biopsy, curettage

Failure documented

to diagnose (Walker

skeletal 1968); the

tuberculosis delay

early

is well in

of 26 months

case 1 may be because the patient received several intraarticubar cortisone injections with temporary symptomatic tions cases relief. Haematobogical are not very helpful the white cell count and radiological investigain diagnosis. In all five of our was normal and the ESR was

All five patients made an excellent recovery following treatment. Clearly the outlook for the patient with a tubercubous elbow is better now than it was in 1953 when, according to Wilson (1953), treatment involved three months in hospital and 1 8 months in plaster. series is that At that time chemotherapy was seldom used. An unusual feature of our

it includes

R. W. Parkinson, FRCS (Glas), FRCS (Ed), Registrar in Orthopaedic Surgery S. P. Hodgson, FRCS, Registrar in Orthopaedic Surgery J. Noble, ChM FRCS (Ed), Consultant Orthopaedic Surgeon Hope Hospital, University of Manchester Medical School, Eccles Old Road, Salford M6 8HD, Lancashire, England. Correspondence to Mr R. W. Parkinson. and Joint Surgery

two cases of tuberculous olecranon bursitis a condition which has been reported only three times before in the English literature (Mishriki and Langan 1984; Holder, Hopson and Vonkuster 1985 ; Newton Ct al 1982). Tuberculosis had not been foremost in our thoughts in either of the two Caucasian patients. One was an athletic, prosperous 42-year-old bank manager (case 2) and the other, a woman with presumed rheumatoid arthritis (case 1).

1990 British Editorial Society ofBone 0301-620X/90/3R67 $2.00 J Bone Joint Surg [Br] 1990; 72-B : 523-4.

VOL.

72-B, No. 3, MAY

1990

524

BRIEF

REPORTS REFERENCES

In conclusion, we stress the importance ing a high level of clinical awareness that

of maintaintuberculosis

of

Holder

the elbow continues to be a clinical problem in the indigenous as well as the immigrant population. We believe that biopsy is mandatory if microscopy and culture are negative. The prognosis for tuberculosis of the elbow with modern chemotherapy is excellent.
No benefits commercial article. in any party form have been related directly received or will be received or indirectly to the subject from a of this

SF, Hopson CN, Vonkuster LC. Tuberculous elbow presenting as chronic bursitis ofthe olecranon JBoneJoint Surg[Am] 1985; 67-A:l 127-9. P. Isolated olecranon 1984; 13:89-92. KL. Bone Ann Rheum recognition and Dis bursitis joint 1982; of of

arthritis : a case

of the report.

Mishriki Y, Langan origin. OrthopRer Newton P, Sharp Manchester

a tuberculous in Greater Br cases. J

J, Barnes 1969-79.

tuberculosis 41 :1-6. skeletal

Walker GF. Failure of early MedJ 1968; i:682-3. Wilson JN. Tuberculosis Bone Joint Surg [Br]

tuberculosis.

of the elbow : a study 1 953 ; 35-B :551-60.

of thirty-one

PAINLESS

REDUCTION BY

OF KOCHERS

SHOULDER METHOD

DISLOCATION

ANAND

J. THAKUR,

RAMACHANDRAN

NARAYAN

Kocher tion Over

described

a method which element

of reducing

anterior

disloca-

anaesthesia anaesthesia. Discussion. remembered, distorted.

and

came

to our catch

unit

for
;

reduction the name

without is usually become It reads:

of the shoulder the years a new

is quoted by which causes

Rang (1966). considerable

Eponyms but Kocher

on easily

pain has been added. We present our experience of the original method, which is painless, gentle, and needs neither anaesthesia nor sedation. Method. First the surgeon tells the patient what is going to happen. Next, to 90#{176} ; the wrist grasped by the the elbow of the affected limb is flexed and the point of the elbow are gently surgeon, and the patient pressed rotated

in time described

the details may his method in 1870.

Bend arm at the elbow, outwards until resistance upper arm and finally this method

press it against the body, rotate is felt. Lift the externally rotated

At all times the arm is kept Slowly the arm is externally

is asked to relax. the humerus (Kessel against the body. up to between 70#{176} applied in the line ofthe did our not recommend opinion that

in the sagittal plane as far as possible forwards turn inwards slowly. Standard references to describe : Gentle, firm traction is applied to 1976), humerus or, Steady traction is (Adams 1983). Kocher was the added later. It is stretch on the
;

and 85#{176}, when resistance is felt. Then the point of the elbow is lifted in the sagittal plane as far as possible. Now the arm is internally rotated. The pain vanishes as the head slips into thejoint. Neither traction nor countertraction are applied at any stage and no assistant is needed. minutes. Results. three had The Eleven patients men can aged leave hospital within (mean a few 34) and

traction. This traction increases

capsule go into creates

and soft tissues and causes more pain spasm causing still more pain. Thus, the need for anaesthesia and sedation. of course necessary before attempting to gain manipulation.

the muscles the traction patients usually

It is confidence

the We

16 to 56 years

women aged 26 to 56 years (mean 38) between them had 16 dislocations; two men each had two All 16 dislocations each the had second were two reduced dislocations both painlessly were refused described. men who with

ask the patients then they do not further. Minimal tion, but constant

to externally rotate the arm actively; resist when the surgeon rotates it a little force is required to reduce the dislocareassurance of painlessness
Medical Superintendent, for permitting the received or or indirectly

dislocations. by the method The two seen elsewhere

is wise.
use Dr R. N. of clinical

; they

Our thanks to Dr S. Pershad, Cooper, Hospital, Juhu, Bombay, material. No benefits from a commercial this article. in any party

form have been related directly

will be received to the subject of

A. J. Thakur, MS (Orth), FCPS, DOrth, Consultant Surgeon R. Narayan, MS (Orth), Registrar in Orthopaedics Armed Forces Hospital, Al Khoud, P0 Box 1726, CPO of Oman. Correspondence to Dr A. J. Thakur. and Joint

Orthopaedic AdamsJC. etc: Out/ineoffractures Churchill Livingstone,

REFERENCES : inc/udingjoint 1983. injuries. In: Wilson 2, 5th ed. 8th ed. Edinburgh, JN, ed. WatsonEdinburgh, etc:

Seeb,

Sultanate

1990 British Editorial Society of Bone 0301 -620X/90/3R66 $2.00 JBoneJointSurg[Br] 1990; 72-B: 524.

Surgery

KesselL. Revised. Injuriesofthe shoulder. Jones fractures and joint injuries. Vol Churchill Livingstone, 1976:521-86. Rang M. Antho/ogv Ltd. 1966. oforthopaedics. Edinburgh,

etc : E & S Livingstone

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