Carries sicca

carries sicca

1. Caries sicca

2. Caries sicca is a rare form of tuberculosis affecting shoulder joint
Incidence is 1-3 % of skeletal tuberculosis Males > females

3. Head of humerus mainly involved Progressively involving glenoid cavity and joint space Predominantly seen in adults Tuberculosis of shoulder joint divided into two forms mainly
Dry form ( caries sicca) Wet / fulminant form ( caries exudata)

4. Caries sicca involves mainly adults Caries fulminant involves mainly children Mainly presented by degenerative changes in shoulder joint involving head of humerus , joint space , glenoid cavity and associated with pain which is aggravated by movements Reduction in joint space is a Delayed finding Advanced cases lead to inferior subluxation of humerus head and fibrous ankylosis

5. Clinical features Presents with pain in insidious onset ,often at night
Patients usually present 3-6 months later due to gradual progression of disease On examination Shoulder muscles atrophy Prominent bony landmarks Reduced movements in all directions and painful
Sometimes misdiagnosed as adhesive capsulitis Generalized tenderness present which is uncommon finding in adhesive capsulitis

6. Radiological findings PHEMISTER’S TRIAD Periarticular osteoporosis Peripheral located bony erosion Gradual narrowing of joint space

7. For confirmatory diagnosis Synovial fluid aspiration and biopsy is recommended to prove histopathologically

8. Differential diagnosis Rheumatoid arthritis Adhesive capsulitis Osteoarthritis Gout Osteochondromatosis

9. In rheumatoid arthrtis , bony erosion and osteoporosis is accompanied by early joint space reduction while in caries sicca joint space reduction is delayed finding and rheumatoid arthrtis may be associated with other clinical features In gout osteoporosis is mild or absent
Adhesive capsulitis , there is no joint space reduction and xray shows normal shoulder joint In osteochondromatosis xray shows calcified and ossified loose bodies

10. Treatment Mainstay of treatment for caries sicca early diagnosis and Anti tubercular chemotherapy Previously shoulder immobilisation with chemotherapy had been recommended But currently early akt drugs and early gentle mobilisation advised to retain functional gain.

11. Patients with delayed presentation and with shoulder arthrosis, surgical management is recommended Shoulder arthroplasty is advised for the functional outcome

12. Thank you