Tuberculosis (TB) is a major public health problem worldwide. It can virtually affect any tissue in the body. Musculo-skeletal forms constitute only 1-3% of all tuberculous infections. Spine is the most common site, followed by peripheral joints. Tuberculosis is a double-edged sword in clinical practice. Making an incorrect diagnosis of tuberculosis is potentially as harmful as missing the diagnosis in true cases. A false positive diagnosis of tuberculosis not only results in ineffective treatment but also administration of antitubercular drugs in these patients can result in toxic side effects. A variety of clinical conditions mimic tuberculosis in bones and joints. Absence of pathognomonic imaging findings in extra-axial osetoarticular TB makes it even more difficult to make an accurate diagnosis radiologically in these patients. Pyogenic and fungal infections, inflammatory arthritis like rheumatoid arthritis are the common mimickers. Differential diagnosis varies according to the site affected, like bone tumours like enchondroma and giant cell tumour may mimic tubercular dactylitis. Clinical and radiological features of the extraspinal osteoarticular TB have been summarized in this review with illustrations. Radiological features and practical points of difference of the clinically relevant mimickers of the musculo-skeletal TB have been summed up.
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