Elbow joint tuberculosis

Introduction to elbow joint tuberculosis Elbow joint tuberculosis ranks first among the three major joints of the upper limbs, accounting for 0.92% of the total body and joint tuberculosis. The patients are the youngest in young adults. The male and female patients are roughly equal to the left and right sides. It is reported that both sides of the elbow joint are affected. Most patients have tuberculosis in other organs. Although the incidence of tuberculosis of the elbow joint is not high, it only accounts for 5.63% of the bone and joint tuberculosis of the whole body, but it is the site with the highest incidence of tuberculosis in the upper limbs and joints. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: abscess swelling

Elbow joint tuberculosis

Cause:

Osteoarthritis and tuberculosis are the same pathogens as Mycobacterium tuberculosis. Mycobacterium tuberculosis is only the main pathogen of human tuberculosis. Mycobacterium tuberculosis is an acid-resistant, inviable bacterium. It is characterized by sensitivity to isoniazid and can produce niacin and catalase. Joint tuberculosis is a secondary tuberculosis, which is often secondary to lung or intestinal tuberculosis, due to trauma, malnutrition, overwork and other incentives. The Mycobacterium tuberculosis in the original tuberculosis in the body is actively spread through the blood to invade the joints or bones. When the body's resistance is reduced, it can reproduce and form lesions, and clinical symptoms appear.

Pathogenesis

Mycobacterium tuberculosis can not directly invade bones and joints, so bone and joint lesions are almost always secondary, that is, through the body's primary lesion of Mycobacterium tuberculosis into the bloodstream and lurking in the bone or joint synovium still viable, but surrounded by fibrous tissue In a state of quiescence, once the body is overworked, malnutrition or other diseases are invaded, and the body's immunity is reduced, the latent tubercle bacilli rapidly multiply, breaking through the fibrous tissue and expanding the inflammation. The pathological features of tuberculosis are Giant cells and epithelial cells form nodules, have a tendency to fibrosis and a special non-liquefied necrotic cheese-like change. The clinicopathological process of bone and joint tuberculosis can be divided into simple bone tuberculosis, simple synovial tuberculosis and total joint tuberculosis. There are three types, and the clinical total joint tuberculosis of the elbow joint is the most common, followed by simple bone tuberculosis, which is mainly ulna olecranon tuberculosis, the humerus external sputum is the second, and the sacral sacral tuberculosis is rare, the elbow joint simple bone tuberculosis It has the characteristics of typical cancellous bone tuberculosis, which is more common in the central type, and rare in the marginal type. The central part is characterized by inflammatory infiltration, granulation, cheese-like substance, pus and small dead bone. After the dead bone is absorbed, a cavity is formed, and the surrounding bone is light and dense. The edge type is the lesion located at the edge of the cancellous bone. Rich in transport, the dead bone is easily absorbed, forming bone defects and abscesses. The marginal abscess is easy to break through and enter the joint to form the whole joint tuberculosis. The simple synovial type tuberculosis of the elbow joint occurs in the synovial membrane of the joint, and the lesion appears early. Swelling, congestion, inflammatory cell infiltration, serous exudate in the joint, synovial hypertrophy in the late stage is dark red, papillary hyperplasia and tuberculous nodules on the synovial surface, caseous necrosis, purulent infiltration in the joint cavity Fluid, simple bone tuberculosis and total joint tuberculosis, can not be effectively treated to break down to form the sinus, mostly in the vicinity of the olecranon behind the elbow, mixed infection at the same time, when the elbow joint is severely damaged, pathological dislocation can occur, when the lesion tends When cured, non-functional fiber stiffness or bony rigidity occurs.

Elbow joint tuberculosis prevention

Because the disease is a secondary disease, the key to prevention is the prevention and treatment of primary lung and intestinal tuberculosis, in order to reduce the incidence of bone and joint tuberculosis. For the formed bone and joint lesions, the principle of early diagnosis and treatment should be implemented. To shorten the course of treatment, reduce disability and reduce the recurrence rate.

In addition to active surgical treatment and anti-tuberculosis medication, you need to pay attention to rest, braking and nutrition.

Elbow joint tuberculosis complications Complications abscess swelling

Complications of elbow joint tuberculosis include the following:

1. Abscess and pupil: The abscess begins to accumulate in the joint, sinking under the fascia and between the tissues, and can be seen under the skin. The abscess sometimes wears the skin to form a pupil, and the skin around the pupil is pus The liquid is irritated to a smashed, dark purple.

2, joint destruction: joint tuberculosis, early joint sputum lesions, pathological products accumulated in the joints, joint swelling, stretching, and thus joint destruction or dislocation; movement restricted.

3, joint swelling: due to joint synovial hypertrophy, joint hypertrophy, edema, granuloma abscess, cheese material caused by joint edema, accompanied by edema, joint skin pale.

4, deformity: with the development of lesions, joint destruction, dislocation, the formation of abscess around the joint can also form pressure on the damaged joint, resulting in hand deformity.

5, treatment can be complicated by fiber rigidity or bony rigidity.

Elbow joint tuberculosis symptoms common symptoms motor dysfunction joint pain weight loss leukocytosis erythrocyte sedimentation increased night sweats abscess hypothermia joint swelling bone destruction

Elbow joint tuberculosis is as slow as other joints. The symptoms are mild at the beginning, mainly manifested as pain, local swelling, tenderness, limited activity, simple bone tuberculosis more than ulnar olecranon, followed by tibia epithelium, swelling and tenderness only Limited to the lesion site, the cold abscess of the olecranon tuberculosis is seen in the vicinity, the external tuberculosis abscess can be injected along the extensor muscle space to the forearm, simple synovial tuberculosis is less common, swelling occurs around the joint, mild swelling first appears elbow three The medial and lateral aspect of the muscle, the humerus, the external iliac crest and the ulnar olecranon are full, the tenderness around the elbow joint is extensive, the lesion develops into the whole joint tuberculosis, the swelling and tenderness are aggravated, the affected limb often has a fusiform swelling, and there are many abscess sinuses. The formation of the tract is more restricted, and the pathological dislocation of the whole joint tuberculosis can be severely damaged. When the elbow joint disease is cured, the joint is stronger than the non-functional position.

Examination of elbow joint tuberculosis

1. During the active period of the disease, the erythrocyte sedimentation rate increases rapidly, the white blood cells are normal or slightly more, and there is often mild anemia. The pus culture is untreated, the positive rate of tuberculosis is about 70%, and the positive rate of synovial culture is 40. About %, pathological examination found typical lesions.

2. X-ray inspection

In the early cases, only osteoporosis and soft tissue swelling, when the development of the whole joint tuberculosis, there may be progressive narrowing of the joint space and changes in the edge of the joint bone erosion, X-ray can also see the lesions of bone tuberculosis, generally larger, located The eagle mouth is more common in the external iliac crest, and the later cases may have pathological dislocation. In the case of secondary infection, there is osteosclerosis.

3. CT examination

It can show the amount of fluid in the joint cavity, early detection of bone tuberculosis lesions and joint edge bone destruction, in the later cases can show the location of cold abscess and the direction of flow.

4. MRI examination

An intraosseous invasive abnormality signal can be detected earlier.

Diagnosis and diagnosis of elbow joint tuberculosis

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Because elbow joint tuberculosis often manifests as pain, local swelling, tenderness, limited activity, etc., these symptoms are not unique manifestations, and clinical manifestations of many diseases are similar, so it is necessary to differentially diagnose these diseases. Including the following diseases:

1. Patients with suppurative osteomyelitis have a history of systemic infection and toxic reactions. The lesions have suppurative inflammatory reactions such as redness, swelling, heat, pain, and onset of illness. The bacterial culture of local puncture fluid is often purulent bacteria.

2, rheumatoid arthritis The disease is multiple, symmetrical joint incidence, rheumatoid factor is often positive, when the identification is difficult, feasible synovial biopsy.

3. Suppurative spondylitis.

4. Tumors.

5, other also include osteoporosis, neurological joint disease, etc. must also be identified.

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