A 45-year-old woman has 8 months of right shoulder pain with gross restriction of all movements and marked wasting of the deltoid and supraspinatus. There is surprisingly little swelling or effusion, and she reports evening fever and weight loss. Radiographs show diffuse osteoporosis and marginal erosions of the humeral head. What is the diagnosis?

• A Adhesive capsulitis (frozen shoulder)
• B Rheumatoid arthritis of the shoulder
• C Rotator cuff tear with disuse osteoporosis
• D Caries sicca, the dry atrophic type of tuberculosis of the shoulder ✓

Explanation

Tuberculosis of the shoulder characteristically takes a dry, atrophic form called caries sicca, with profound muscle wasting, restriction of movements, and minimal pus or effusion. Constitutional symptoms plus marginal erosions on radiograph confirm infection. Frozen shoulder produces identical restriction and wasting but never causes osseous erosions or systemic features, which kills this distractor.

Reference: Tuli's Textbook of Tuberculosis of the Skeletal System, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.