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Musculoskeletal and Sports Medicine

A Rare Case of Shoulder Pain Secondary to Tuberculosis Arthritis: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 3

    Primary Author(s)

  • Brandon Burg, DO

    PGY-4
    New York University Grossman School of Medicine Rusk PM&R Program
    Syosset, New York

    • Co-Author(s)

  • RS

    Robert Steinberg, Other

    Medical Student
    New York Institute of Technology College of Osteopathic Medicine
    Lake Ronkonkoma, New York

  • HI

    Haruki Ishii, MD

    Clinical Assistant Prifessor
    NYU
    Jersey City, New Jersey

Disclosure(s):
Brandon Burg, DO: No financial relationships to disclose
Case Diagnosis: Tuberculosis Arthritis.

Case Description or Program Description: 32-year-old man with a remote history of treated Tuberculosis (TB) presented with progressive chronic left shoulder pain. Pain is described as constant, exacerbated with shoulder range of motion (ROM), and not alleviated with NSAIDs. Prior to moving to the US, he underwent an extensive workup including imaging of the shoulder and two biopsies, and was diagnosed with severe arthritis likely secondary to the sequela of his TB infection. Treatment included NSAIDs and home exercise program without improvement.

Setting: Outpatient PM&R Sports Medicine Clinic.

Assessment/Results: Examination revealed significantly reduced shoulder ROM in all planes and diffuse tenderness to palpation with mild weakness. Positive impingement signs, rotator cuff, and biceps tendon provocative maneuvers were appreciated. X-ray revealed severe glenohumeral joint osteoarthritis with articular erosions and subchondral cysts, reflecting the sequelae of previous TB infection. MRI demonstrated end-stage glenohumeral joint osteoarthritis with chronic bone remodeling and subchondral cysts.

Discussion (relevance): TB arthritis is a rare cause of musculoskeletal pain that occurs in 1-3% of cases of TB, and 11% of extrapulmonary TB cases. This is distinct from Poncet’s Disease, a reactive arthritis associated with active TB that typically resolves with treatment. Medical therapy alone is recommended for early cases of TB arthritis. In cases with substantial joint destruction or chronic pain, surgical management including excisional arthroplasty, arthrodesis, or total joint arthroplasty is considered. As TB arthritis is most commonly seen in weight-bearing joints, it is often mistaken for adhesive capsulitis when present in the shoulder in early stages, delaying treatment. It is important to have TB arthritis as a differential for patients from endemic regions or with previous TB infection to ensure proper diagnosis and timely interventions.

Conclusions: Although arthritis secondary to TB is uncommon, it is important to consider this in the differential diagnosis for patients with previous TB infection or from endemic regions.