Clinical Outcomes of Arthroscopic Treatment for Shoulder Joint Tuberculosis

Shoulder joint tuberculosis is a rare form of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis. Early diagnosis is challenging, and it can lead to severe symptoms in the later stages. Currently, there are few relevant studies on the treatment and diagnosis of this disease. This study aimed to assess the effects of early diagnosis and treatment of shoulder tuberculosis under arthroscopy.

Between January 2015 and January 2025, 18 patients with confirmed or clinically suspected shoulder tuberculosis underwent arthroscopic debridement and synovectomy after at least 3 weeks of antitubercular therapy. The clinical outcomes were evaluated including the rate of recurrence, Pain Visual Analogue Scale (VAS) scores, University of California at Los Angeles (UCLA) shoulder scores, American Shoulder and Elbow Surgeons (ASES) scores, and Constant-Murley scores through follow-up. Regular postoperative follow-up tests for erythrocyte sedimentation rate, C-reactive protein and liver and kidney functions were conducted.

All patients successfully completed the surgery without complications. The final diagnosis of shoulder tuberculosis was established in all 18 patients based on postoperative tissue examination. Characteristic tuberculous histopathological findings were identified in 13 patients (72.2%), while the remaining 5 patients were diagnosed based on further tissue-based testing and compatible clinical, imaging, and arthroscopic findings. The mean follow-up period was 54 months. Mean ESR decreased from 39.7±26.8 mm/h preoperatively to 9.1±3.6 mm/h at 3 months, and mean CRP decreased from 12.9±11.4 mg/L preoperatively to 2.9±1.1 mg/L at 6 weeks. The postoperative VAS score decreased from 4 to 1 (P < 0.001), ASES score increased from 62 to 90 (P < 0.001), UCLA score increased from 17 to 32 (P < 0.001), and Constant-Murley score increased from 54 to 87 (P < 0.001) at the final follow-up. Two patients experienced recurrence and achieved clinical cure after second arthroscopic surgery.

Arthroscopic debridement combined with anti-tuberculosis drugs has good therapeutic effect with less invasiveness, low recurrence rate, fewer complications and postoperative joint function improvement.