Ortho

1. TUBERCULOUS ARTHRITIS OF
RIGHT ELBOW JOINT
Dr. V. R. Raghul, M.S. 2nd Year PG, Department of Orthopaedics
Prof. Dr. Nalli R Yuvraj, HOD - Department of Orthopaedics
Dr. Pradeep E, Associate Professor
Dr. Arun K V, Associate Professor
Chettinad Hospital and Research Institute, Kelambakkam

2. INTRODUCTION
Incidence of TB elbow: 2-5% of
all skeletal locations.
The elbow joint is the most
frequently involved joint in
tubercular infections of the
upper limb.
Despite substantial progression
of the disease and ambiguous
symptoms, necessary evaluation
are not performed.
TB arthritis is often
misdiagnosed.

3. CASE REPORT
A 55-year-old male with complaints of pain over right elbow for
past 6 months.
Swelling and difficulty in movement for past 3 months.
H/o loss of weight. (5kgs lost in the past 6 months)
No other history of constitutional symptoms.
NO H/O cough with expectoration

4. L/E OF RIGHT ELBOW
5*3cm swelling present over
posteromedial aspect of elbow
extending into distal arm
Muscle wasting present over forearm,
biceps, triceps
Warmth present
Non tender
Firm in consistency
Mobile
Elbow ROM: FFD 60° to 100°; further
restricted and painful
Pre-op Images

5. RADIOGRAPHS
Right elbow shows arthritic changes:
AP view
Lateral view

6. MRI
MRI right elbow showed inflamed synovium and joint effusion,

7. RADIOGRAPH OF CHEST
PA view
Non homogenous opacities
seen in right upper zone and
lower zone and left upper zone
and mid zone.

8. INVESTIGATIONS
ESR and CRP elevated.
Mantoux positive (17mm)
Sputum for AFB was sent and
was positive

9. SURGERY
Excision biopsy of the
swelling was done
Sent for histopathology gene
xpert and microbiology

12. LJ media: shows typical
rough and tough buff-
colored colonies
AFB: Long slender,
beaded, less uniformly
stained and red
coloured acid-fast
acid-fast bacilli
MGIT Tube:
Mycobacterial
Growth Indicator
Tube from tissue bit
and pus was positive.
Rapid card test:
Card Test for
Mycobacterium
tuberculosis
yielded a
positive result

13. Histopathology Report: Features consistent with caseating granulomatous
inflammation.

14. DIAGNOSIS
Tuberculous Arthritis of right elbow joint
Patient was started on ATT
• FDC
• 4 HRZE for 2 months (Intensive phase)
followed by 4 HRE continuation phase,
patient is in the 5th month maintenance
phase

15. 6 MONTHS FOLLOW UP

16. 6 MONTHS FOLLOW UP

17. RADIOGRAPHS
AP view
Lateral view

18. DISCUSSION
Osteoarticular TB and AIDS have
grown increasingly widespread in
developing countries.
Increased HIV incidence due to factors like
immigration, alcoholism, chronic diseases,
homelessness, and limited healthcare access.
Osteoarticular tuberculosis affects
1%-3% of cases, with 2%-4% in
immuno-depressed individuals.
Osteoarticular TB primarily affects spinal,
upper limb joints, and elbows.

19. DISCUSSION
Tubercle bacilli spread from pulmonary lesions
cause musculoskeletal involvement.
Tuberculous arthritis causes chronic pain, edema,
and function loss, with slow diagnosis and poor
therapy outcomes.
50% of individuals have no radiological pulmonary
involvement, TB history possible.
Positive tuberculin skin test confirms diagnosis,
negative results don't rule out TB.

20. DISCUSSION
Early lesions may be missed due to non-specific radiological
findings; periarticular osteopenia may progress, leading to joint
narrowing.
Joint obliteration, fibrous ankylosis, osteoarticular tuberculosis,
osteoporosis, erosions, and progressive cartilage constriction
may develop without treatment.
MRI assesses soft-tissue masses, 99mTc bone scans detect
osteomyelitis early.
CT-guided percutaneous biopsy aids diagnosis, mycobacterial
culture confirms diagnosis, and biopsies are the best tool for early
treatment in osteoarticular TB.

21. DISCUSSION
Disability is determined by diagnosis and treatment period for
osteoarticular tuberculosis.
Osteoarticular tuberculosis treated with chemotherapy and non weight-
bearing joint exercises.
Osteoarticular tuberculosis treated with chemotherapy and joint
exercises.
Surgery may be necessary for biopsy and confirmation, and joint
arthrodesis or replacement may be considered.

22. CONCLUSION
In conclusion, immunocompromised and endemic individuals with
unexplained soft-tissue edema, swelling, and discomfort should be
investigated for osteoarticular tuberculosis.
Early diagnosis and therapy may improve function.
An enlarged elbow should be checked for pyogen
arthritis, gout, pigmented villonodular synovitis,
haemophilic arthropathy, rheumatoid arthritis, synovial
osteochondromatosis, and malignancies.

23. REFERENCES
1. Tangadulrat P, Suwannaphisit S (March 08, 2021) Tuberculosis Septic Arthritis of the Elbow: A
Case Report and Literature Review. Cureus 13(3): e13765. doi:10.7759/cureus.13765
2. Domingo, A., Nomdedeu, M., Tomás, X. et al. Elbow tuberculosis: an unusual location and
diagnostic problem. Arch Orthop Trauma Surg 125, 56–58 (2005).
3. Dhillon MS, Goel A, Prabhakar S, Aggarwal S, Bachhal V. Tuberculosis of the elbow: A
clinicoradiological analysis. Indian J Orthop. 2012 Mar;46(2):200-5.

24. THANK YOU