Clinical and radiological presentation of tuberculosis of the elbow

The diagnosis of tuberculosis of the elbow is often missed in the early stages, so that irreversible osteoarticular destruction may occur. The authors describe their experience with 48 elbows in 47 patients. Most patients were in the first three decades of life. All patients presented with pain, swelling and loss of motion. Sixteen elbows had discharging sinuses. Eight elbows had a palpable supratrochlear lymph node. Six were completely ankylosed in flexion, at an angle of 73.3 degrees on average; the other elbows had a mean range of motion from 31.3 degrees to 105.2 degrees. Plain radiographs showed periosteal reaction in 6 elbows without discharging sinus and thus free of superinfection, and para-articular round to oval lytic lesions in 29. According to the radiological classification of Martini, 6 elbows were in stage 1, 13 in stage 2, 20 in stage 3 and 9 in stage 4. All the patients were treated conservatively with antituberculous drugs for a minimum period of 9 months. Twenty-seven elbows were available for follow-up, with a minimum follow-up period of 9 months. The functional results were related to the radiological stage at presentation, not to the duration of symptoms or to the initial loss of range of motion.