Tuberculous
arthritis
Tuberculous arthritis can be of slightly more insidious onset than acute
septic arthritis, but nevertheless the pressure within the joint causes severe
pain. The joint is held in the position of comfort but the redness and swelling
may not be so pronounced. However, there is marked wasting of the muscles around
the joint. The child will be very unwilling to move the joint, and the muscles
around the joint may be in tight spasm, preventing it moving. This leads to the
characteristic feature of ‘night cries’. When the child finally falls asleep
the muscle spasm decreases and the joint moves. The child awakes with a
characteristic cry of pain.
The
treatment once again is decompression of the joint and identification of the
organism as soon as possible, then treatment with the appropriate antibiotics.
Synovectomy may well be useful, especially if the diagnosis is delayed (as is
usual). In tuberculosis the ankylosis is usually fibrous and therefore unstable.
Once the infection is brought under control there may then be a place for
carrying out a formal bony arthrodesis with the limb in the position of
function.