Tuberculosis of the elbow: A clinicoradiological analysis

Abstract

Background:The incidence of Tuberculosis (TB) of elbow is 2-5% of all skeletal locations. Most reports of TB elbow have focused attention on the diagnosis. The management options and classification has been missing. We present a retrospective clinicoradiological analysis of 38 cases (40 elbows) of TB of elbow joint.Materials and Methods:The patients presented with pain, swelling and loss of motion. Two cases had bilateral involvement. The average delay between onset of symptoms and presentation was 8 months. The elbows were classified according to modified Martini's radiological classification, which distinguishes between osseous lesions close to joint line (e.g. coronoid, condyles) and lesions away from the joint line (e.g. epicondyles, olecranon). We modified the classification to subdivide into para-articular bony lesions that had invaded the joint and those that were threatening to invade joint. All patients received antitubercular chemotherapy and immobilization in above-elbow plaster slab for 4–8 weeks. Twenty patients underwent surgical interventions (synovectomy, intraarticular debridement).Results:The average followup period was 5.3 years (range 1.5-14.2 years). The range of movement at final followup averaged 107° for stage 2, 90° for stage 3A, 47° for stage 3B and 32° for stage 4. Range of supination and pronation was less satisfactory as compared to flexion and extension and all elbows with bony involvement had less than 90° arc of supination and pronation.Conclusion:Surgical intervention could appreciably alter the outcome especially in patients with extra-articular involvement close to the joint. We have classified this subgroup separately.

Magnetic resonance imaging findings in tubercular arthritis of elbow

“…In the study by Vohra et al [15], all patients had pain and restricted motion (n= 10), and 7 patients had swelling. Similar results were reported by Dhillon et al [14]. In the present study, pain was the most common presentation (100%) followed by restricted motion (93%) and local swelling (71.5%).…”

“…In other studies, enlarged lymph nodes were reported in one third to all the patients [16,17]. In the study by Dhillon et al [14], the supratrochlear (n=4) and axillary (n=3) lymph nodes were reported. Vohra et al [15] reported supratrochlear and/or axillary lymph nodes involvement in 4 cases.…”

“…Right elbow was more frequently affected (55%). Two cases of bilateral involvement were also reported [14]. In a series of 10 patients of tubercular arthritis of elbow by Vohra et al [15], mean age was 36 years and there was a male predominance (n= 7).…”

“…A female predominance has been reported in large series; however, few series have reported the disease to occur more commonly in males [13][14][15]. A preferential involvement of right elbow has been reported.…”

“…Right elbow involvement (64.6%) was more common than left elbow involvement. In a retrospective study of 38 patients with tuberculosis of the elbow, Dhillon et al [14] reported a mean age of 33 years with female predominance (60.5%). Right elbow was more frequently affected (55%).…”