carries sicca

1. Caries sicca

2. • Caries sicca is a rare form of tuberculosis affecting shoulder joint
• Incidence is 1-3 % of skeletal tuberculosis
• Males > females

3. • Head of humerus mainly involved
• Progressively involving glenoid cavity and joint space
• Predominantly seen in adults
• Tuberculosis of shoulder joint divided into two forms mainly
• Dry form ( caries sicca)
• Wet / fulminant form ( caries exudata)

4. • Caries sicca involves mainly adults
• Caries fulminant involves mainly children
• Mainly presented by degenerative changes in shoulder joint involving
head of humerus , joint space , glenoid cavity and associated with
pain which is aggravated by movements
• Reduction in joint space is a Delayed finding
• Advanced cases lead to inferior subluxation of humerus head and
fibrous ankylosis

5. Clinical features
• Presents with pain in insidious onset ,often at night
• Patients usually present 3-6 months later due to gradual progression
of disease
• On examination
• Shoulder muscles atrophy
• Prominent bony landmarks
• Reduced movements in all directions and painful
• Sometimes misdiagnosed as adhesive capsulitis
• Generalized tenderness present which is uncommon finding in adhesive
capsulitis

6. Radiological findings
• PHEMISTER’S TRIAD
• Periarticular osteoporosis
• Peripheral located bony erosion
• Gradual narrowing of joint space

7. • For confirmatory diagnosis
• Synovial fluid aspiration and biopsy is recommended to prove histopathologically
•

8. • Differential diagnosis
• Rheumatoid arthritis
• Adhesive capsulitis
• Osteoarthritis
• Gout
• Osteochondromatosis

9. • In rheumatoid arthrtis , bony erosion and osteoporosis is
accompanied by early joint space reduction while in caries sicca joint
space reduction is delayed finding and rheumatoid arthrtis may be
associated with other clinical features
• In gout osteoporosis is mild or absent
• Adhesive capsulitis , there is no joint space reduction and xray shows
normal shoulder joint
• In osteochondromatosis xray shows calcified and ossified loose bodies

10. Treatment
• Mainstay of treatment for caries sicca
early diagnosis and Anti tubercular chemotherapy
• Previously shoulder immobilisation with chemotherapy had been
recommended
• But currently early akt drugs and early gentle mobilisation advised to
retain functional gain.

11. • Patients with delayed presentation and with shoulder arthrosis,
surgical management is recommended
• Shoulder arthroplasty is advised for the functional outcome

12. Thank you