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Musculoskeletal tuberculosis

Musculoskeletal tuberculosis is a form of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis involving the bones, joints, spine, and surrounding soft tissues. The spine is the most common site, followed by large weight-bearing joints such as the hip and knee. It usually presents with chronic pain, swelling, stiffness, constitutional symptoms, and progressive deformity, and treatment is based primarily on anti-tubercular therapy, with surgery reserved for selected complications.

Musculoskeletal tuberculosis is a chronic granulomatous infection of the bones and joints caused by Mycobacterium tuberculosis, usually through haematogenous spread from a primary focus. It most commonly affects the spine (Pott disease), followed by the hip, knee, and other major joints. Patients often present insidiously with persistent pain, swelling, stiffness, restricted movement, muscle wasting, and constitutional symptoms such as fever, weight loss, or night sweats. Because the disease progresses slowly, diagnosis is often delayed. In spinal tuberculosis, vertebral destruction may lead to kyphotic deformity, cold abscess formation, neurological deficit, or spinal instability. Imaging plays an important role in diagnosis. Plain radiographs may show joint-space narrowing, periarticular osteopenia, erosions, vertebral destruction, or deformity, while MRI is particularly useful for detecting early marrow involvement, abscesses, soft-tissue extension, and neural compression. Definitive diagnosis is ideally established by tissue biopsy with histopathology, microbiological culture, and molecular tests. Treatment is primarily with appropriate multidrug anti-tubercular therapy along with nutritional support, protected mobilisation, and physiotherapy. Surgery may be required in cases of neurological deficit, instability, severe deformity, large abscesses, diagnostic uncertainty, or failure of medical treatment. The goals of management are to eradicate infection, preserve joint and neurological function, maintain stability, prevent deformity, and restore mobility.

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Osteogenesis imperfecta (OI)

Osteogenesis imperfecta (OI) is a group of inherited connective-tissue disorders characterized by increased bone fragility and recurrent fractures, most commonly due to abnormalities in type I collagen. Clinical features may include blue sclera, dentinogenesis imperfecta, hearing loss, short stature, and skeletal deformity. Severity varies widely from mild disease with few fractures to severe forms causing marked deformity and perinatal mortality.

Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE) is an adolescent hip disorder in which the femoral neck displaces anterosuperiorly relative to the capital femoral epiphysis through the proximal femoral physis. It commonly occurs during the growth spurt, especially in overweight adolescents, and may present with hip, groin, thigh, or referred knee pain with a limp. Early diagnosis and stabilization are important to prevent further slip and complications such as avascular necrosis and femoroacetabular impingement.

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Common Orthopaedic Angles and Measurements

Osteomyelitis

Osteomyelitis is an infection of bone caused most commonly by bacteria, particularly Staphylococcus aureus. Acute osteomyelitis usually presents with pain, fever, local tenderness, swelling, and raised inflammatory markers, while chronic osteomyelitis is characterized by persistent or recurrent infection with features such as sequestrum, involucrum, cloaca, and discharging sinus. Treatment combines appropriate antibiotics with surgical drainage or debridement when necessary.

Patellar instability

Patellar instability refers to recurrent or persistent tendency of the patella to subluxate or dislocate from the trochlear groove, most commonly in the lateral direction. It is usually related to a combination of traumatic injury and anatomical risk factors such as trochlear dysplasia, patella alta, increased TT–TG distance, and abnormal limb alignment. Patients typically present with anterior knee pain, apprehension, recurrent giving way, or episodes of patellar dislocation.

Musculoskeletal tuberculosis

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