Bone and Joint Tb
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Transcript of Bone and Joint Tb
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OSTEO-
ARTICULAR
TUBERCULOSISDr. Chandrakant Nallulwar
Prof. & H.O.D.
Dept. of Orthopaedics
SDMCMSH
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Epidemiology
1. Commonest through out the world
2. Decline in last 60 -70 years because ofeffective public health programme and
advanced chemotherapy3. Increase in last two decades
4. Eg.extra pulmanry tuberculosis has
increased a) population b) I.V drug abusers
c) Emerging AIDS
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PATHOLOGY
Causative org- Mycobacterium
tuberculosis
acid fast bacillus- human
bovine
Chronic granulomatus lesion with
caseating necrosisPrimary complex-Mantoux test,
heaf test
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Synovial tissue involvement
earlier to joint involvementTuberculosis granuloma chronic
inflamatory reaction
Epitheloid & multi nucleolated
giant cells surrounding central
caseation due to necrosis withround cell infiltration at periphery
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Coalition of small lesions creates
large yallowish mass convertingin cold abcess
Containing pus & necrotic bonematerial
Bone lesion spreads in to the
joints as epiphyseal cartlage is no
barrier for invasion & joint gets
affected
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In vertibral bodies & short-long bones
osteo-lytic lesion remains withoutperiosteal reaction known as
tuberculous osteomylitis or
tuberculous ductilitisSynovial hypotrophy leads to swelling
and effusion leading to subchondral
bone erosionSubsequently cartilage gets eroded
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Damaged articular cartilage heals
by fibrosis leading to fibrousankylosis & progressive joint
deformity
The lesion may remain dormant
for many years & may get
reactivated after many years ofstopping the treatment
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Clinical Features
Painful swelling of a joint
Fever, loss of wt., loss of apetite
Loss of wt
Night cries
Restriction of joint movements
DeformityLoss of function with wasting of
surrounding muscles
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Spine - Reduction in disc space
- Collapse of vertibra
- Bird nest abscess
X-ray chest, C. T. & MRI
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Investigations
Haemogramme
C. R. P.
Mantoux testSynovial fluid examination
Synovial biopsy
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Differential Diagnosis
Transient synovitis of hip
Mono-articular rheumatoid
arthritis
Haemophilic arthritis
Sub-acute septic arthritisBruselosis
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THANK YOU