Clinical Spectrum and Management Pathways in Tuberculosis of the Shoulder: Synthesis of Published Evidence

Tuberculosis of the shoulder joint remains one of the rarest and most underreported forms, contributing to delays in diagnosis and potentially poor functional outcomes. Limited awareness and non-specific early symptoms lead to misdiagnosis as adhesive capsulitis, rotator cuff pathology, or degenerative arthritis. This review, as the first comprehensive review on this topic, summarizes current concepts in the epidemiology, pathogenesis, clinical presentation, diagnostic strategies, and management of shoulder joint tuberculosis. Evidence was synthesized from 34 published reports available in the existing literature. Articles were screened for relevance to clinical presentation, diagnostic modalities, treatment protocols, and outcomes of tuberculous arthritis of the shoulder. The disease exhibits two clinico-radiological patterns: caries sicca, a dry, atrophic form with predominant wasting, and caries exudata, an effusive, destructive type with joint space involvement. MRI was the most sensitive imaging modality for early detection, while histopathology and mycobacterial culture/PCR confirmed diagnosis. Anti-tubercular therapy (ATT) remains the cornerstone of treatment. Most patients achieved favorable outcomes with ATT, with or without selective surgical intervention, depending on disease severity. Surgery is selectively indicated for synovectomy, abscess drainage, biopsy, instability, or end-stage deformity. Shoulder tuberculosis is uncommon yet clinically significant. High suspicion, early imaging, and timely biopsy are essential for diagnosis. Combined medical therapy with selective surgery yields good outcomes. Further prospective studies are needed to standardize treatment and rehabilitation protocols.