April 11, 2024

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
Tuberculosis of the elbow joint

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

  1. Chemotherapy
  2. Early excision of focus + Chemotherapy + Immobilization in a functional position
  3. Excision is for advanced disease with the destruction of bone ends and pus collection and discharging sinus
  4. Other options:
    1. Excision arthroplasty ( For mobile joint)
    2. Arthotomy and excision of focus ( Non-responders or advanced disease)
    3. Arthrodesis (Heavy manual laborers)
      • Unilateral at 90 degrees and bilateral with the functional elbow at 110 degrees and next at 60 degrees
    4. 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

FindingsCongenitalTraumatic
BilateralCommonUncommon
Trauma+
The shape of the radial head(Anterior)
Dome-shaped without central disruptionNormal shape
(Posterior)Elongated and narrow headNormal
Ulnar bowPresentAbsent
CapitellumHypoplastic/ absentNormal
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.