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| Year : 2007 | Volume
: 1
| Issue : 4 | Page : 117-118 |
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LETTER TO EDITOR Septic arthritis of the shoulder: Analysis of 19 cases
JA Fernandez-Valencia, S Garcia, S Suso
Department of Orthopedic Surgery, Hospital Clinic, University of Barcelona, C/Villarroel 170, E-08036-Barcelona, Spain
Correspondence Address:
J A Fernandez-Valencia
Department of Orthopedic Surgery, Hospital Clinic, University of Barcelona, C/Villarroel 170, E-08036-Barcelona
Spain
DOI: 10.4103/0973-6042.37114 |
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How to cite this article:
Fernandez-Valencia J A, Garcia S, Suso S. Septic arthritis of the shoulder: Analysis of 19 cases. Int J Shoulder Surg 2007;1:117-8 |
Septic arthritis of the shoulder is uncommon. Diagnose is difficult and requires a high suspicion index. The present study aims to describe the experience at our Center over a period of 10 years.
We retrospectively evaluated all adult patients admitted during the period 1 January 1992 to 31 December 2002 with a hematogenous septic arthritis of the shoulder and a minimum follow-up of one year. Patients with an open joint and patients who had any previous surgery to the affected joint were also excluded. Diagnose was confirmed by aspiration or drainage of pus from the affected joint and/or by positive synovial fluid or blood cultures and/or prompt clinical response to drainage and antibiotic therapy. Of 25 identified patients, 19 accomplished the inclusion criteria; 11 women and 8 men with an average age of 57.6 years (SD 15.6). We evaluated the clinical features, microbiology, image studies, complications and final results.
The reason of the admission to the hospital was due to the septic arthritis of the shoulder in 8 patients (42.1%), while 11 were admitted due to other diseases (57.1%). Thirteen of the 19 cases had comorbidities, being cirrhosis of the liver (four cases) and cancer (four cases) the most common. A previous injection or aspiration of the shoulder was reported in four patients, three of which had cirrhosis of the liver. At the clinical onset the erythrocyte sedimentation rate was always elevated. In the cases that the protein C-reactive was determined (8 of 19), it was also elevated, except for one patient. Radiographic images were slightly illustrative in five patients; the imaging study was extended to magnetic resonance in seven patients [Figure - 1], sonography in three patients and body scan in two patients and bone scintigraphy in one patient. The most prevalent germs were Staphylococcus aureus  (8) and Streptococcus spp. (3). A different septic location was identified in three cases: 2 spondylodiscitis (Staphyloccocus aureus and M. tuberculosis) and a septic arthritis of the hip (Staphyloccocus aureus). Antibiotic and ancillary treatment was administered in all the cases and needle drainage was performed in 17 cases and repeated in three cases (namely; 2, 4 and 6 times). Open surgical debridement was indicated initially in two cases and in other three after an unsatisfactory evolution; in three of the five patients the indication was due to a septic shock. In the follow-up, one patient developed osteomyelitis and another recurred the septic arthritis twice. Two patients died at 12 and 14 months, due to other diseases. At final follow-up, the functional result was satisfactory in the 57% of the patients.
Septic arthritis of the shoulder diagnose is based in clinical, microbiological and analytic data but frequently image studies are of value. [1] The present study has several limitations: it is retrospective, complete data were not available for every patient and the treatment was not standardized. As previously reported, Staphylococcus aureus was the most common isolated germ. [3],[4],[5] The presence of another septic focus is not common but it must be ruled out, especially for M.tuberculosis . A high index of suspicion for septic arthritis is necessary for all patients with shoulder complaints, but especially for inhospital patients treated for other diseases. In the present series an injection or aspiration of the shoulder showed a high risk for infection in patients affected of cirrhosis of the liver.
Although the early setting-up of antibiotic treatment is related to good prognoses, serious complications such as septic shock, osteomyelitis or relapse of the arthritis can occur. In order to prevent these complications, a prompt diagnose and surgical treatment are recommended. [2],[5]
 References | |  |
| 1. | Gelberman RH, Menon J, Austerlitz MS, Weisman MH. Pyogenic arthritis of the shoulder in adults. J Bone Joint Surg Am 1980;62:550-3.  [PUBMED] |
| 2. | Jeon I, Choi C, Seo J, Seo K, Ko S, Park J. Arthroscopic management of septic arthritis of the shoulder joint. J Bone Joint Surg Am 2006;88:1802-6. |
| 3. | Leslie BM, Harris JM 3 rd , Driscoll D. Septic arthritis of the shoulder in adults. J Bone Joint Surg Am 1989;71:1516-22. |
| 4. | Lossos IS, Yossepowitch O, Kandel L, Yardeni D, Arber N. Septic arthritis of the glenohumeral joint: A report of 11 cases and review of the literature. Medicine 1998;77:177-87. [PUBMED] [FULLTEXT] |
| 5. | Mehta P, Schnall SB, Zalavras CG. Septic arthritis of the shoulder, elbow and wrist. Clin Orthop Relat Res 2006;451:42-5. [PUBMED] [FULLTEXT] |
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