Tuberculosis of the upper limb joints

Area of Science:

• Orthopedics
• Infectious Diseases
• Rheumatology

Background:

• Tuberculosis (TB) of the upper limb joints is a significant clinical challenge.
• Many cases present at advanced stages of joint destruction.
• Effective management strategies are crucial for preserving function.

Purpose of the Study:

• To review the outcomes of conservative management for upper limb joint tuberculosis.
• To evaluate the efficacy of chemotherapy, immobilization, and rehabilitation.
• To compare conservative approaches with surgical interventions like arthrodesis.

Main Methods:

• Retrospective review of 74 cases of upper limb joint tuberculosis treated by the authors.
• Treatment included 6-12 months of chemotherapy, plaster immobilization (except for sterno-clavicular and finger joints), and functional rehabilitation.
• Diagnosis was confirmed in 71 out of 74 cases.

Main Results:

• 87% of cases presented with advanced joint destruction.
• Chemotherapy was effective in 66 followed-up patients, with one relapse.
• Shoulder joints healed with stiffness but were painless. Elbows showed varied outcomes including spontaneous fusion and useful range of motion. Wrist and finger joints healed with stiffness, with early rehabilitation mitigating functional impact in fingers.

Conclusions:

• Conservative management, including chemotherapy and functional rehabilitation, generally yields better results than arthrodesis or joint excision for upper limb tuberculosis.
• Early initiation of rehabilitation is key to preserving function, particularly in finger joint tuberculosis.
• While joint stiffness can occur, conservative treatment often leads to painless and functional outcomes.