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SKELETAL

TUBERCULOSIS
ACHMAD AMINUDDIN

SKELETAL TUBERCULOSIS

Tuberculosis of the bones and joints is responsible for


10 % of extrapulmonary cases.
Pathogenesis is related to reactivation of
hematogenous foci or to spread from adiacent
paravertebral lymph nodes.
Weight-bearing joints, are affected most commonly.
Spinal tuberculosis ( Potts disease or tuberculous
spondylitis ); often involves two or more adiacent
vertebral bodies

SKELETAL TUBERCULOSIS

The upper thoracic spine is the most common site of


spinal tuberculosis in children, the lower thoracic and
upper lumbar vertebrae are usually affected in adults.
From the anterior superior or inferior angle of the
vertebral body, the lesion reaches the adiacent
body,also distroying the intervertebral disk.
With advanced disease, collapse of vertebral bodies
results in kyphosis ( gibbus ).
A paravertebral cold abscess may also form. In the
upper spine, this abscess may track to the chest wall
as a mass ; in the lower spine, it may reach the
inguinal ligaments or present as a psoas abscess.

SYMPTOMS AND SIGNS

The onset of symptoms is generally incidious and not


accompanied by general manifestations of fever,
sweating, toxicity or prostation.
Pain may be mild at onset, is usually worse at night,
and may be accompanies by stiffness.
As the disease process progress, limitation of joint
motion becom prominent because of muscle
contractures and joint distruction.
The knee is the most commonly involved peripheral
joint.
Symptom of pulmonary tuberculosis may also be
present.

SYMPTOMS AND SIGNS

Local findings during the early stages may be limited


to tenderness, soft tissue swellling,joint effusion, and
increase in skin temperature about the involved area.
As the diseae progresses without treatment, muscle
atrophy and deformity become apparent.
Abscess formation with spontaneous drainage
externally leads to sinus formation.
Progressive distructin of bone in the spine may cause
a hump spine or gibbus deformity, especially in the
thoracolumbar region.

IMAGING

Soft tissue swelling and distention of the joint


capsule by effusion.
Bone atrophy causes thinning of the trabecular
pattern,narrowing og he cortex, and
enlargement of the medullary canal.
Destruction of the cartilage is manifested by
narrowing of the joint cleft and focal erosion
of the articular surface, especially at the
margins

COMPLICATIONS

Deformity due to joint destruction, abscess


formation with spread into adjacent soft tissue
and sinus formation.
Paraplegia.
As healing of severe joint leions take place,
spontaneous fibrous or bony ankylosis

SKELETAL TUBECULOSIS

Diagnosis ; - aspiration of the abscess or


- bone biopsy.
- biopsy of a regional lymph node.
Complication of Potts disease is paraplegia, which is usually
due to an abscess or a lesion compressing the spinal cord.
Paraparesis due to large abscess is a medical emergency and
requires abscess drainage.
Tuberculosis of the hip joints, causes pain and limping ;
tuberculosis of the knee produces pain and swelling and
sometimes following trauma.
If the disease goes unrecognized, the joints may be destroyed.

TREATMENT

General measures
- general care.
- skillful nursing care must be provided.
Chemotherapy
- regimen that are effective for treating pulmo
nary tuberculosis are also effective for treatig
extrapulmonary disease.
- many experts recomended 9 months of therapy
when miliarry, meningeal or bone and joint disease
is present
Surgical measures

TREATMENT

Surgical measure
- early surgical drainage.
- debridement of necrotic bne.
- synovectomy may be valuable for less acute
hypertrophic lesion that involve tendon sheat
, bursae or joints