Tuberculosis of the upper limb joints

Abstract

Seventy-four cases of tuberculosis of the upper limb joints (sterno-clavicular 1; shoulder 12; elbow 42; wrist 10 and fingers 9), treated by two of the authors, were reviewed. Eighty-seven percent presented at an advanced stage of destruction. The diagnosis was proved in 71 our of 74 cases. In most, the treatment was 6-12 months of chemotherapy, plaster immobilization (in order to prevent or correct deformity) and functional rehabilitation whenever possible. The sterno-clavicular and finger joints were not immobilized. Response to chemotherapy was favourable in 66 of the patients followed up. One relapse occurred at the 18th month. The affected shoulder joints healed with loss of movement, but were not painful. At the elbow, ten patients developed spontaneous bony fusion in the right-angle position, 27 had a useful range of motion and 19 had more than 70 degrees of flexion-extension movement. One patient had an arthrodesis. At the wrist, two patients healed with painful stiffness and an arthrodesis was performed. All the finger lesions healed with painless stiffness which did not interfere much with function because rehabilitation had been started early. The authors believe that conservative management usually gives better results than arthrodesis or excision of the joint.

Tuberculosis of the elbow: A clinicoradiological analysis

“…Nine cases in our series presented with ankylosis or residual movement less than 20°, and all went on to heal with a stiff but painless and stable elbow. This has also been the experience of previous authors 613…”

“…The patients were classified into four stages using a classification that was modified from Martini's original radiographic classification67 [Table 1] and we correlated these retrospectively with the treatment protocols employed. Stage 1 included those without any evident radiological osseous lesions.…”

“…Wilson (1953),4 managed cases with prolonged immobilization and classified the condition radiologically. Martini et al 56. classified the cases into four radiological types and the treatment was based on the severity of radiological involvement 7.…”

“…classified the cases into four radiological types and the treatment was based on the severity of radiological involvement 7. In most of the reports of TB elbow has focused attention on the unique diagnosis 368. The management options and classification has been missing.…”

“…We present a retrospective analysis of patients of TB elbow. Our study led us to modify the existing radiological classification67 and distinguish between osseous lesions present away from and those present close to the joint. This may be helpful in prognosticating the functional end result and defining the management options.…”