Shoulder Joint Tuberculosis

Shoulder TB is relatively rare, accounting for only 1.06% of systemic osteoarticular TB, more common in adults (Turek, 1977), peak 21-30. Most are young/middle-aged with active pulmonary TB; slightly more males, left side slightly more. History of TB or contact. Because periarticular muscles are rich and local blood supply good, abscesses are readily absorbed, so shoulder TB was formerly called dry caries, though this is uncommon.

Common Symptoms

Bony destruction; osteoporosis; nodule; sequestrum; referred pain; bone sclerosis; secondary infection; soft tissue swelling; abscess

Causes and Pathogenesis

Bacterial infection: Primary lesions arise in the epiphysis/metaphysis, with infiltration and dissolution causing caseation and tuberculous granulation; liquefaction forms tuberculous pus with destructive cavities containing pus and sequestra; pus enters the joint causing synovial changes and total joint TB. Synovial abnormality: Slowly progressive; months to years before bony destruction. Early synovitis causes congestion, hypertrophy, and tuberculous granulation with serous effusion, fibrin deposits, and tuberculous pus undermining articular cartilage. Pyarthrosis may penetrate the joint forming sinuses with secondary infection. Anatomical factors: The humeral anatomical neck and glenoid fossa are common sites; children may have entire humeral metaphyseal involvement, forming large fibrous-caseous cavities that deform the humeral head with joint capsule contracture and fibrous ankylosis. After onset, deltoid and supraspinatus/infraspinatus rapidly atrophy; long-standing dependent limb posture may cause subluxation; destruction of the proximal humeral epiphysis in children causes shortening. Adjacent lesions (acromion, subacromial bursa, supraclavicular/axillary nodes) may spread to the shoulder.

Treatment

Drug therapy, supportive therapy, rehabilitation

Preventive Measures

Focus on controlling TB infection. 1. Early diagnosis and treatment to prevent deterioration and spread. 2. Screen close contacts (family), including tuberculin skin tests and/or chest X-rays for children. 3. Healthy living: TB strikes when resistance declines. 4. BCG vaccination: health departments provide BCG for newborns; children under 15 who have never received it should be vaccinated.

Department to Visit

It is recommended to visit the Infectious Diseases department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.