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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.