Tuberculosis of the clavicle is a rare lesion, accounting for less than 1% of all
osteoarticular tuberculosis. The lesion has been described in a few case reports. The lesion can have a varied presentation, ranging from dull, aching
pain to bony swelling and a draining sinus. The rarity of the lesion, its nonspecific symptoms, and its striking resemblance to common cystic conditions such as bone
tumors and metabolic conditions such as
rickets make diagnosis difficult. The authors describe a series of 17 patients with primary
tuberculosis of the clavicle. Radiographs and magnetic resonance images were obtained for all patients, and a preliminary diagnosis was made on the basis of clinical features and the results of erythrocyte sedimentation rate,
C-reactive protein, and Mantoux tests. Erythrocyte sedimentation rate was uniformly elevated. Radiographs showed diffused thickening and honeycombing, eccentric expansile lytic lesions with surrounding
osteopenia, or sequestration not unlike pyogenic
infection. Magnetic resonance imaging is useful for determining the extent of the lesion and soft tissue involvement. The radiological and laboratory findings provided complementary information. The diagnosis was confirmed on biopsy material that was analyzed with histopathology,
pus culture and sensitivities, gram
stain,
acid-fast
stain, and cultures on Löwenstein-Jensen medium. Patients were treated with multidrug antitubercular
chemotherapy for 18 months and were assessed on pre- and posttreatment radiology, erythrocyte sedimentation rate, and University of California, Los Angeles (UCLA) shoulder rating scale. The results of
conservative management of tubercular
osteomyelitis were uniformly good, and all patients recovered well.