Shevate Ishan, Walia Sarthak, Mahida Kishankumar, Salunkhe Rahul, Aggarwal Rishabh
Department of Orthopaedics, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.
J Orthop Case Rep. 2025 May;15(5):29-32. doi: 10.13107/jocr.2025.v15.i05.5544.
Tuberculosis (TB) remains a significant health issue in India, with approximately 30-40% incidence. While only 18% of TB cases are extrapulmonary, shoulder TB, particularly Caries sicca, is extremely rare. Caries sicca is characterized by severe pain, restricted shoulder movements, and significant muscle wasting, often resulting in avascular necrosis (AVN) of the humeral head.
This case report describes the management and rehabilitation of a 38-year-old woman with shoulder TB and AVN. The patient presented with a 5-year history of persistent shoulder pain and restricted motion. Radiological and histopathological examinations confirmed osteonecrosis and TB. The treatment involved arthroscopic debridement, antitubercular therapy, and staged surgical intervention including the placement of an iliac crest bone graft and antibiotic cement spacer, followed by reverse shoulder replacement.
Tubercular shoulder is challenging to diagnose and manage. Anti-tuberculosis treatment (ATT) combined with the use of an antibiotic-coated cement spacer provides an effective strategy to eradicate infection and prepare the joint for future replacement. Early diagnosis and a staged approach are essential to address joint destruction and restore functionality, ensuring better outcomes for patients.
结核病（TB）在印度仍然是一个重大的健康问题，发病率约为30%-40%。虽然只有18%的结核病病例是肺外结核，但肩部结核，尤其是干性骨疡型结核极为罕见。干性骨疡型结核的特征是严重疼痛、肩部活动受限和明显的肌肉萎缩，常导致肱骨头缺血性坏死（AVN）。
本病例报告描述了一名患有肩部结核和缺血性坏死的38岁女性的治疗和康复情况。患者有5年持续肩部疼痛和活动受限的病史。放射学和组织病理学检查证实了骨坏死和结核病。治疗包括关节镜清创、抗结核治疗以及分阶段手术干预，包括植入髂嵴骨移植和抗生素骨水泥间隔物，随后进行反式肩关节置换。
结核性肩部疾病的诊断和治疗具有挑战性。抗结核治疗（ATT）联合使用抗生素涂层骨水泥间隔物提供了一种有效的策略，以根除感染并为未来的关节置换做好准备。早期诊断和分阶段治疗方法对于解决关节破坏和恢复功能至关重要，可确保患者获得更好的治疗效果。
