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Sinus Tract Formation After Arthroplasty of the Shoulder Secondary to TuberculosisA Case Report and Review of the Literature
Adam Cochran, MD1; Lynn A. Crosby, MD2; Julie Barre, MD3
1 Department of Orthopaedic Surgery, University of Louisville, 550 South Jackson Street, 1st floor ACB, Louisville, KY 40206
2 937 15th Street, Augusta, GA 30912. E-mail address: lycrosby@gru.edu
3 1665 Kingsley Avenue, Suite 107, Orange Park, FL 32073
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Investigation performed at the Department of Orthopaedic Surgery, Medical College of Georgia, Georgia Regents University, Augusta, Georgia

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jun 12;3(2):e53 1-4. doi: 10.2106/JBJS.CC.L.00105
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Since reporting of tuberculosis (TB) first began in the 1950s, Mycobacterium tuberculosis infection rates have steadily declined in the United States; in 2011, the lowest number of TB cases, as well as the lowest rate of infection to date, was recorded1. Of these cases, approximately 60% were in patients born outside of the United States1. Approximately 20% of all cases of TB are extrapulmonary, with 11% involving the bones and/or joints2. Skeletal TB most commonly involves the spine; knee and hip joints are the next most commonly affected areas3. Patients with bone and/or joint TB commonly present with pain, swelling, and/or a draining sinus4-10. These signs and symptoms are common to joint infections from other sources, however, and thus a higher degree of suspicion for TB may be warranted only in the absence of obvious sources of infection. This case report demonstrates the difficulty of making the diagnosis of a TB joint infection, but also provides valuable information for when to suspect TB. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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