International Journal of Research in Orthopaedics | July-August 2019 | Vol 5 | Issue 4 Page 747 International Journal of Research in Orthopaedics Goel V et al. Int J Res Orthop. 2019 Jul;5(4):747-749 http://www.ijoro.org Case Report Caries sicca: tuberculosis of glenohumeral joint Varun Goel 1 *, Pankaj Kumar Sharma 1 , Jalaz Jain 1 , Umesh Yadav 1 , Ashish Devgan 1 , Neha Bhardwaj 2 INTRODUCTION Tuberculosis is one of the leading causes of morbidity and mortality in India. The incidence of tuberculosis in India is 30-40 %. 1 Most common type of tuberculosis is pulmonary and only 18% cases are extrapulmonary tuberculosis. Among the extrapulmonary cases only 8% are skeletal tuberculosis and shoulder tuberculosis is still rarer, accounting to only 0.9 – 1.7 % of them. 2,3 Extrapulmonary spread of tuberculosis is mainly via hematogenous route from pulmonary foci. The common sites of extrapulmonary tuberculosis are abdominal, lymph nodes, skeletal tuberculosis etc. Skeletal tuberculosis can apparently occur in any bone but the most common sites are spine ( Pott’s disease), knee joint, hip joint and less commonly in shoulder, wrist, elbow, small bones of hand ( Spina Ventosa ) etc. Shoulder tuberculosis can be of 3 types, Type 1- Caries Sicca, also called as atrophic form or dry form. In this type of shoulder tuberculosis there is severe pain and restriction of shoulder movements along with severe muscle wasting. It is mainly seen in adults. Type 2- Caries Exudata, also known as florid or fulminating type. Commonly seen in children and presents with swelling and cold abscess with or without sinus formation. Type 3- Caries mobile, so called as there is good range of passive movements, although active movements are restricted. 3 CASE REPORT Twenty year old female patient who was 2 months postpartum, delivered baby 2 months back, presented with complaints of non-traumatic mild pain in right shoulder joint since 6 months. Patient had severe restriction of movements of shoulder joint. She took multiple treatments and was managed conservatively for adhesive capsulitis of shoulder joint, rotator cuff injury, shoulder joint arthritis etc. No X-rays were done as the patient was pregnant. No blood or any other investigations were done despite continuous worsening of the local symptoms. On examination, the patient had minimal swelling with no local redness. There was no local rise of temperature but there was tenderness over ABSTRACT Tuberculosis is quite common in India. Shoulder tuberculosis although rare among the skeletal tuberculosis needs to be kept in mind for diagnosis and proper treatment of cases of Carries Sicca. Twenty year old female presented with non traumatic pain in right shoulder with severe restriction of shoulder Range of Movements (ROM), not responding to treatment. On detailed examination turned out to be a case of Caries Sicca. Thorough debridement along with sufficient immobilization and Anti Tubercular Treatment (ATT) gives excellent results. High suspicion is needed to diagnose the cases of Carries Sicca. Early diagnosis and proper treatment gives wonderful results. Only ATT with or without immobilization and debridement are sufficient enough in majority of cases. Keywords: Caries Sicca, Tuberculosis shoulder joint, Musculoskeletal Tuberculosis 1 Department of Orthopaedics, Pt. B.D.Sharma PGIMS Rohtak, Haryana, India 2 Adesh Institute of Medical Sciences, Bhatinda, Punjab, India Received: 10 April 2019 Revised: 17 May 2019 Accepted: 17 May 2019 *Correspondence: Dr. Varun Goel, E-mail: dr.goelvarun@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192696