Square shoulder deformity

Introduction Because the joint cavity is empty, there is no humeral head, and the shoulders are protruding, forming a typical square shoulder deformity. Shoulder joint tuberculosis has a square shoulder deformity. Shoulder joint tuberculosis is relatively rare, accounting for only 1.06% of total body and joint tuberculosis. Adults are more common than children (Turek, 1977), with 21 to 30 years old. Most of the young and middle-aged patients have active tuberculosis at the same time. Gender, male is slightly higher than female. The left side is slightly more than the right side.

Cause

(1) Causes of the disease

The incidence of shoulder tuberculosis is the lowest among the three major joints of the upper limbs. It occurs mostly in young adults aged 20 to 30 years old. The disease is complicated by tuberculosis infection, which is caused by the infection of tuberculosis in the blood circulation of the joint synovial membrane or metaphysis.

(two) pathogenesis

The shoulder joint is more common with dry lesions, characterized by exudation and swelling are not obvious, but mainly atrophy.

At the beginning, tuberculosis can stay in the metaphysis of the synovial membrane or epiphysis of the joint, followed by infection into the joint cavity (Campos, 1955; Bosworth, 1959).

The primary lesion of tuberculosis originates from the metaphysis of the epiphysis. The bacteria and bacteria are infiltrated and diffuse, and osteolysis and necrosis occur. The cheese-like substance is formed, accompanied by tuberculous granulation tissue. The cheese-like substance dissolves into tuberculous pus and bone appears. Destructive cavity (containing pus and dead bone), so the pus enters the joint cavity, synovial changes occur, and total joint tuberculosis occurs.

The primary lesion of tuberculosis originates from the synovial membrane of the joint and develops slowly. It can cause bone destruction several months or years later. At the onset of the disease, synovial tuberculous inflammation, hyperemia, hyperplasia, hypertrophy, tuberculous granulation nodules, serous exudation, joint effusion, cellulose deposition into cellulose blocks, tuberculous pus formation, invasion of joint edge bone (Subchondral septic destruction, cartilage necrosis), bone destruction, leading to total joint tuberculosis.

Joint empyema can break through the joints, forming tuberculosis sinus or fistula, and then secondary infection (Boyd, 1953).

Primary synovitis is rare, and the anatomical neck of the humerus and the scapula are often affected. The joint is filled with tuberculous granulation tissue. Childhood lesions can affect the metaphysis of the entire humerus. The humeral head is fused into a large fibrous cheese cavity by a number of small scattered lesions that deform the humeral head. The joint capsule is contracted, the joint is fibrous and straight, and joint movement is often limited (Turek, 1977).

After the onset of the shoulder joint, the muscles around the joint capsule, such as the deltoid muscle and the superior and inferior muscles, can rapidly undergo a disabling atrophy. In a small number of cases, due to prolonged limb sagging, the humeral head subluxation occurs. If the lesion destroys the epiphysis of the upper humerus of the child, short limb deformity may occur in the future.

Sometimes the spread of tuberculosis in adjacent areas (such as the shoulder or shoulder sac) can also violate the shoulder joint. Tuberculosis in the supraclavicular fossa, axillary or anterior tibial lymph nodes, and occasional shoulder tuberculosis.

an examination

Related inspection

CT examination of mammography

1.X-ray performance

In the early cases, only osteoporosis and soft tissue swelling were observed. When X-ray signs appear, most have evolved into total joint tuberculosis, with bone destruction as the main performance. Bone destruction can occur at the shoulder, humeral head, shoulder and large nodules, with dead bone formation; more manifested as narrowing of joint space and bone destruction at the edge of the joint. In advanced cases, the bone destruction is severe, the humeral head partially disappears, and even there is a partial dislocation. Because the destruction of the epiphysis of the upper end of the humerus affects the development of the humeral head, it is manifested as the reduction or even disappearance of the humeral head. Patients with secondary infections have osteosclerosis.

2. CT examination

Regarding the effusion in the sacral cavity, and early detection of bone destruction at the edge of the joint; in the later cases, it showed obvious bone destruction and dead bone, and also showed the size and flow direction of the cold abscess in the extra-articular soft tissue space.

3. MRI examination

An abnormal signal of intra-articular effusion and intra-inflammatory inflammatory infiltration can be found earlier.

Differential diagnosis

Differential diagnosis of square shoulder deformity:

1, frozen shoulder: frozen shoulder is also known as frozen shoulder, adhesive shoulder arthritis, fifty shoulders and so on. It is caused by shoulder tissue pain and active dysfunction due to soft tissue lesions around the shoulder joint. Occurs in patients over 40 years old, more women than men (about 3:1), more than the left shoulder than the right shoulder. It is characterized by shoulder pain and shoulder movement disorder gradually increasing. After several months or even longer, the pain gradually subsides, the function slowly recovers, and finally heal itself.

2, dislocation after shoulder joint: post-shoulder dislocation is less common, one of the reasons is that there is strong muscle group protection behind the shoulder joint, it is difficult to pull back; even after the occurrence of dislocation, it is easy to be due to the tensile stress of the posterior muscle group Nano, so it is rare in clinical practice.

3, scapula protruding: thin body, shoulder blade protruding, looks very unattractive. The so-called scapula wing-like protrusion refers to the shoulder blade behind the sides. Due to muscle stability or nerve damage, it can be seen in a natural state, or the arm can do certain movements to see a prominent situation.

4, condensed shoulder: computer shoulder referred to as frozen shoulder (now less used), commonly known as frozen shoulder (frozen shoulder). It is a chronic injurious inflammation of the shoulder muscles, tendons, bursae and joint capsules. Due to hyperplasia, roughness and internal and external adhesions, it is clinically characterized by pain and function limitation during activity.

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