1/55. Tuberculosis of the ankle: report of four cases.Tuberculosis of the ankle joint is relatively uncommon, and the treatment usually includes chemotherapy, immobilization and non-weight bearing protection. It is easily confused with pyogenic arthritis, which often leads to delayed diagnosis. We reviewed the records of 4 patients with ankle tuberculosis with advanced articular lesions without evidence of pulmonary tuberculosis. They took antituberculous agents for 5 to 6 months. Two of them had positive bacterial cultures, and all four had initially received surgical management under the impression of pyogenic osteomyelitis. Two patients underwent arthrodesis and the other two synovectomy with debridement. The clinical and radiologic results were better in the patients who underwent arthrodesis. We consider surgery with open biopsy of a painful swelling ankle to be helpful in the differential diagnosis of tuberculous and pyogenic arthritis. arthrodesis in patients with severe osteoarticular destruction of the ankle provides a better prognosis and more stable joint than other treatment methods.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
2/55. Tuberculous arthritis of the knee--an unusual presentation.A 54 year old male who had an unusual clinical manifestation and radiological features proven to have tuberculosis arthritis of the knee on synovial biopsy is presented here.- - - - - - - - - - ranking = 2.5keywords = arthritis (Clic here for more details about this article) |
3/55. Total hip arthroplasty for tuberculous coxitis.We report a case of tuberculous arthritis of the hip in a 22 year old male patient, treated with arthrotomy and antituberculous antibiotic therapy for 9 months; the joint deteriorated and 2 years later he underwent uncemented total hip arthroplasty. He received antibiotic therapy for 3 months preoperatively and for 6 months postoperatively. At 5 year follow-up there was no evidence of recurrent infection.- - - - - - - - - - ranking = 0.5keywords = arthritis (Clic here for more details about this article) |
4/55. Insidious destruction of the hip by mycobacterium tuberculosis and why early diagnosis is critical.Tuberculosis has re-emerged as an important problem in the united states. More than 10 million people presently are infected with mycobacterium tuberculosis in the united states alone. The symptoms at first presentation of the disease have become more diverse. With extrapulmonary manifestations, such as musculoskeletal infections, as the sole presenting sign, it often can be difficult to determine the correct diagnosis early in the course of the disease. The presenting symptoms, physical signs, and radiographic findings of intra-articular tuberculosis can mimic those of other intra-articular diseases, such as rheumatoid arthritis, osteoarthritis, and avascular necrosis. In view of the nonspecific findings early in course of the disease, tubercular infection should be considered in the differential diagnosis when there is insidious articular destruction. Failure to consider tuberculosis can lead to devastating outcomes otherwise preventable with today's chemotherapies.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
5/55. Isolated tuberculous monoarthritis mimicking oligoarticular juvenile rheumatoid arthritis.Isolated monoarthritis caused by mycobacterium tuberculosis in the absence of clinical pulmonary disease is extremely rare in north america. After decades of consistent declines in incidence, a remarkable resurgence of tuberculosis (TB) is occurring in north america. It must always be considered in the differential diagnosis of chronic monoarthritis if devastating sequelae are to be avoided. We describe 2 cases of tuberculous arthritis in young children presenting with monoarthritis of the knee. The presumptive diagnosis in each case was oligoarticular onset juvenile rheumatoid arthritis (JRA). Each had an atypical course for JRA, with lack of response to intraarticular corticosteroid. The diagnosis of TB arthritis was made only with synovial biopsy.- - - - - - - - - - ranking = 7keywords = arthritis (Clic here for more details about this article) |
6/55. Osteoarticular tuberculosis: current diagnosis and treatment.Tuberculous synovitis frequently presents as a monoarthritis of weight-bearing joints such as the hip, knee, or ankle. Owing to its low incidence in developed countries, the diagnosis is often delayed for months to years. early diagnosis with a synovial biopsy permits prompt antituberculous therapy and substantially improves the prospect of preservation of joint structure and function. Initial treatment typically includes combination therapy with four drugs (isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol) because of the frequency of isoniazid resistance. Antimicrobial therapy should be of at least 9 months' duration, longer in immunocompromised hosts. Partial synovectomy and other surgical procedures should be restricted to joints with severe cartilage destruction, large abscesses, joint deformity, multiple drug resistance, or atypical mycobacteria.- - - - - - - - - - ranking = 0.5keywords = arthritis (Clic here for more details about this article) |
7/55. Physical therapist management of tuberculous arthritis of the elbow.BACKGROUND AND PURPOSE: Tuberculous arthritis is not commonly seen by physical therapists in the united states. The purpose of this case report is to describe a case of tuberculous arthritis of the elbow. CASE DESCRIPTION: The patient was a 36-year-old man referred for physical therapy evaluation and intervention for chronic elbow pain. After an evaluation and a trial of physical therapy, the patient was referred back to a primary care provider for additional tests to rule out systemic pathology. An open debridement of synovium and biopsy of the capitellum and radial head was positive for acid-fast bacilli, which was later identified as mycobacterium tuberculosis. OUTCOMES: The patient was placed on a 4-drug antituberculosis regimen that resolved all patient complaints and restored full elbow function. DISCUSSION: Tuberculous arthritis has characteristic findings during examination and in diagnostic tests. Although tuberculous arthritis is uncommon, it should be considered when patients have chronic or vague musculoskeletal complaints.- - - - - - - - - - ranking = 4keywords = arthritis (Clic here for more details about this article) |
8/55. Tuberculous synovitis of the elbow joint.Tuberculous synovitis in the elbow joint is extremely rare in developed countries. We describe a 68-year-old man who had had a gradually enlarging mass over the volar side of the left proximal forearm near the elbow joint for 4 months. Plain roentgenograms of the diseased elbow showed early osteoarthritic change. magnetic resonance imaging revealed diffuse synovitis with a large 8 x 8 cm extra-articular synovial cyst. Synovectomy was performed and histopathologic examination of the surgical specimen revealed granulomatous inflammation with caseation, prominent Langhan's giant cells, and sparse acid-fast bacilli. The patient had been receiving antituberculous chemotherapy for at least 8 months at the time of examination and had no recurrence of swelling or discharging sinuses during follow-up. Differential diagnoses in patients with elbow swelling should include pigmented villonodular synovitis, hemophilic arthropathy, rheumatoid arthritis, degenerative joint disease, and tuberculosis. Simple aspiration may enable earlier diagnosis, before destructive arthropathy becomes advanced.- - - - - - - - - - ranking = 0.5keywords = arthritis (Clic here for more details about this article) |
9/55. Tuberculous arthritis mimic arthritis of the sjogren's syndrome: findings from sonography, computed tomography and magnetic resonance images.A patient with a history of sjogren's syndrome developed chronic arthritis of left ankle. It was diagnosed as arthritis of the sjogren's syndrome initially. However, joint pain persisted despite corticosteroid therapy. Sonography disclosed a multiloculated cystic lesion with peripheral hyperechoic enhancement around left ankle and extended to achilles tendon and subcutaneous region. Computed tomography (CT) confirmed the findings. magnetic resonance imaging (MRI) revealed increased signal intensity of the lesion after gadonillium enhancement on T1-weighted images. These abnormalities showed inhomogenous high signal intensities on T2-weighted images. Tuberculous arthritis was diagnosed by positive synovial tuberculous culture. Sonography is a valuable tool that offers significant advantages for the initial evaluation of arthritis of the sjogren's syndrome and help early suspicious of tuberculous arthritis, because of its cost-effectiveness, superior differentiation between the cyst and solid lesions, convenience for guiding biopsy and drainage.- - - - - - - - - - ranking = 6.5keywords = arthritis (Clic here for more details about this article) |
10/55. The supratrochlear lymph nodes: their diagnostic significance in a swollen elbow joint.In the differential diagnosis of a swollen elbow, the palpation of the supratrochlear glands is useful. They are not enlarged in a traumatic elbow joint. They are enlarged, discrete and shotty in rheumatoid arthritis. In tuberculosis, they are enlarged, matted and they may caseate and form a cold abscess on the medial aspect of the supratrochlear region of the arm.- - - - - - - - - - ranking = 0.5keywords = arthritis (Clic here for more details about this article) |
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