A Rare Case of Shoulder Tuberculosis Managed with Anti-tuberculosis Treatment and Antibiotic Coated Cement Spacer

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.