TUBERCULOSIS OF

BONES & JOINTS

Tuberculous Arthritis
By: Yik
Group 29
Faculty of General Medicine

Possible Pathology
Joint

Arthritis TB

Synovial TB

Others

TB Tenosynovitis

TB Bursitis

General View in TB of Bones and Joints

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

Risk Group

Tuberculous Arthritis /Arthropathy

The most common form of articular tuberculosis is

spondylitis followed by arthritis of weight bearing
joints (especially knee and hip). The spine is the
most common site followed by the hip joint which
constitutes 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.

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 involved)

Weight loss or loss of appetite

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

Physical Findings
Hip Joint Lesion

Gait Lameness

Muscle wasting ( Thigh, gluteal )

Swelling around hip

Discharging sinuses

Deformities

One-shortening of limb length

Muscle spasm

Radiological Findings
Phimsters Triad

Reduction of Joint Space

Erosion of articular surface

Peri-Articular Osteoporosis

On the basis of radiological features tubercular arthropathy can be devide into:

Early stages (stage of synovitis and arthritis) - radiographic features include

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 cartilage)
severe subchondral erosion and destruction
pathological subluxation and dislocation
fibrous ankylosis - in contrast to pyogenic arthritis, the development of bone
ankylosis is uncommon in tuberculous arthritis and, when present, is more
likely to be secondary to prior surgical intervention
atrophic changes in bones may occur and lead to atrophic arthropathy (seen
in shoulder joint as carries sicca)

TB of the Hip

Lesion in left sacro-iliac joint

Lesion in right gleno-humeral joint

Other Investigations:

Blood Analysis : Lymphocytic leukocytosis, High ESR

Mantoux Test : Postive

Synovial Fluid Aspiration : Low Viscosity, Yellowish, translucent, Increased WBC,

decrease glucose level, Positive Culture

*Additional diagnosis: CT, MRI, Biopsy

Treatment

Standard Anti-Tuberculosis Chemotherapy + conservative skin traction

*If present severe joint destruction:

>Operative treatment:
1)Joint debridement
2)Arthoplasty

3)Arthrodesis
4) Synovectomy

Joint Debridement

Athroplasty

Arthrodesis

Thank you for your attention.