Tuberculosis of the elbow joint is an uncommon form of Tuberculosis of the joints.
Clinical Features
- Boggy swelling and effusion at the elbow joint
- Wasting of forearm and arm muscles
- Flexion deformity of the elbow joint
- Axillary lymphadenopathy
Foci of Infections
- Olecranon
- Distal humerus
- Radial head
- Synovial membrane
Investigation
Investigations of tuberculosis in detail.
Xray features
- Diffuse osteopenia
- Lytic foci
- Periosteal reaction
- Decrease joint space
- Deformity
- Pathological posterior dislocation of joint
- Spina ventosa of proximal ulna
Spinal ventosa: Loculated expansile appearances resembling dilated bone due to air. Often seen in the thin bones of hands and feet
Management of Tuberculosis of Elbow Joint
- Chemotherapy
- Early excision of focus + Chemotherapy + Immobilization in a functional position
- Excision is for advanced disease with the destruction of bone ends and pus collection and discharging sinus
- Other options:
- Excision arthroplasty ( For mobile joint)
- Arthotomy and excision of focus ( Non-responders or advanced disease)
- Arthrodesis (Heavy manual laborers)
- Unilateral at 90 degrees and bilateral with the functional elbow at 110 degrees and next at 60 degrees
- Arthroplasty
See also: Spinal tuberculosis (Pott’s Spine)
See also: The Unstable Elbow
Old Unreduced Monteggia Fracture Dislocation
Old is called if it is greater than 3 weeks
| Findings | Congenital | Traumatic |
|---|---|---|
| Bilateral | Common | Uncommon |
| Trauma | – | + |
| The shape of the radial head(Anterior) | Dome-shaped without central disruption | Normal shape |
| (Posterior) | Elongated and narrow head | Normal |
| Ulnar bow | Present | Absent |
| Capitellum | Hypoplastic/ absent | Normal |
| Other congenital anomalies | + | _ |
Motion severely restricted in monteggia fracture/ dislocation is ‘SUPINATION’.
Nerve injury: PIN> AIN> Ulnar nerve
Monteggia lesion: A group of lesions having in common a radio-humero-ulnar-joint dislocation associated with an ulnar fracture at various levels or with the lesion of the wrist
Treatment:
Open reduction of the radial head with annular ligament reconstruction and ulnar lengthening/corrective osteotomy + Radial head fixation using transcapitellar wires.
