Tuberculosis of the subdeltoid bursa; a review, with a report of two cases.

Tuberculosis of the shoulder joint represents less than 1 per cent of all bone and joint tuberculosis, and affection of the subdeltoid bursa is still less common. It receives scant, if indeed any, mention in current British and American orthopaedic text-books, and since it is possible that the occasional case which does occur may be incorrectly diagnosed in the earlier stages, when treatment should be most effective, a brief review of the condition is presented, together with a report of two cases. The previous literature was reviewed by Cone when he reported a proven case in 1911. He considered that Acrel’s description in 1779 of the “ Ganglion Crepitans Acrellii “ containing rice bodies was one of the earliest accounts of tuberculous bursitis, but in fact neither this account nor the descriptions of Cruveilhier in 1816 and of Dupuytren in 1839 of “ cysts” containing rice bodies can be considered as proven cases. At that time the true pathology of the condition was not understood, and tuberculous, syphilitic and simple non-specific chronic bursitis were probably not clearly differentiated. For instance, Dupuytren thought that the cysts he described were hydatidiform cysts and that the rice bodies were parasites. The fibrinous nature of the rice bodies was first demonstrated in 1 856 by Virchow, who began the controversy on the mode of their formation. The discovery of the tubercle bacillus and the subsequent clarification of the pathology made it possible to differentiate tuberculous bursitis with certainty. It is now generally accepted that rice-body formation is not peculiar to tuberculous bursitis.