This is an automatically translated article.
1. The concept of shoulder tuberculosis
The shoulder joint is a large and dynamic joint. Tuberculosis of the shoulder is an inflammation of the shoulder joint caused by tuberculosis bacteria. Tuberculosis of the shoulder is often a secondary injury to pulmonary tuberculosis. TB bacteria, after passing through the lungs or gastrointestinal system, will follow the blood or lymphatic route to stay in a part of the musculoskeletal system.
When the shoulder is injured, the patient will have pain and limited movement of the shoulder joint. The shoulder joint with tuberculosis often quickly becomes attached and the joint space narrows. In addition, tuberculosis of the shoulder joint often produces pus, creating an abscess. Tuberculous abscesses often include pus, gangrene, dead bone fragments, and possibly inflamed bone marrow. Pus that forms in tuberculosis of the shoulder joint may spread to the armpit or arm to form pus-filled sacs; can rupture leaving pus fistulas to the front, back of the shoulder joint or in the armpit.
Diagnosis of shoulder tuberculosis should be based on clinical symptoms and imaging such as shoulder X-ray, shoulder ultrasound and shoulder magnetic resonance imaging to avoid missing lesions.
If diagnosed early and treated correctly, shoulder tuberculosis can be cured completely. But if the disease is prolonged, causing delay in treatment, TB bacteria will destroy articular cartilage and subchondral bone, weakening the shoulder joint, making it difficult to move the shoulder joint, and even increasing the rate of disability.
Khi bị tổn thương lao khớp vai, người bệnh sẽ đau và hạn chế vận động khớp vai
2. Surgical curettage of shoulder tuberculosis
Tuberculosis of the shoulder joint is treated medically with anti-tuberculosis drugs and shoulder mobility physiotherapy to help patients restore shoulder joint function.
Surgical curettage of shoulder tuberculosis is a surgical method that is often combined with medical treatment to quickly resolve the patient's infection and pain symptoms. Shoulder arthroplasty is indicated when tuberculosis of the shoulder joint forms an abscess, with dead bone fragments that need curettage and drainage. Patients should be treated with anti-tuberculosis drugs for at least 2 weeks prior to surgical curettage of shoulder tuberculosis.
Dredging of the shoulder tuberculosis will be performed after the joint capsule is opened, and at the same time, the abscess will be found to cure it. During the shoulder curettage, the surgeon will take the damaged tissue for histopathological examination, take pus for gram stain, Ziehl-Neelsen stain, and culture for bacteria to make antibiotics. Inflammatory joints were washed several times with physiological saline. Irrigation is through placing two polytene drainage tubes in the cavity of the abscess, leaving the tubes to drain for 7 to 10 days. In the case of tuberculosis of the shoulder joint with a purulent fistula, surgery is often simpler by being able to widen the fistula and then follow the direction of the fistula to cure the shoulder joint and place a drainage.
Lao khớp vai được điều trị nội khoa bằng thuốc kháng lao và vật lý trị liệu vận động khớp vai
In the early stages for about 4 to 5 weeks, the patient needs to rest to give the joint time to recover by lying on a hard bed, avoiding soft mattress. Tuberculosis of the shoulder joint does not require a cast to be absolutely immobilized. After that, the patient must exercise the shoulder joint with increasing intensity to avoid stiffness and joint deformity.
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