Case Report A Case of Septic Arthritis of Shoulder ... · shoulder pain associated with stiffness. In the setting of suspected septic arthritis, diagnosis should be confirmed as soon
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1Department of Orthopaedics, K.G hospital and P.G medical institute, Coimbatore, India..
Address of Correspondence
Dr. Mukesh Atturu
Orthopaedics resident, K.G hospital and P.G medical institute, Arts college road, Coimbatore, Tamilnadu, India- 641018.
Journal of Orthopaedic Case Reports 2016 April-June: 6(2):Page 31-33Case Report
Introduction: Septic arthritis of the shoulder is uncommon in adults. It is a surgical emergency as joint destruction occurs
rapidly and can lead to significant morbidity and mortality. Accurate diagnosis can be particularly challenging in patients with underlying liver disease. MRI is a useful adjunct in early detection of atypical causes of shoulder pain.
Case report: A 43 years old male came to our outpatient department with complaints of pain and stiffness of his left shoulder.
On examination, his shoulder movements were severely restricted. Further evaluation with MRI revealed septic arthritis of left gleno-humeral joint for which emergency arthroscopic debridement was done.
Conclusion: Septic arthritis of shoulder may not present with classical clinical features. Hence, a through clinical and
radiological evaluation will help us prognosticate and treat accordingly thereby preventing complications like septic shock, osteomyelitis.
Key Words: Arthritis, Shoulder joint, stiffness.
What to Learn from this Article? Septic arthritis can presents as stiff shoulders in immunocompromised patients.
Senthil Nathan Sambandam¹, Mukesh Atturu¹
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Website:www.jocr.co.in
DOI:2250-0685.418
A Case of Septic Arthritis of Shoulder Presenting as Stiffness of the Shoulder
Introduction
Patients with septic arthritis usually develop moderate to severe
joint pain, warmth, tenderness, effusion, restricted active and
passive motion, and sometimes redness. We report an unusual
presentation of shoulder septic arthritis in a 43 years old man with
no other clinical signs and symptoms of classical septic arthritis.
Case Report
A 43-year-old man presented to the orthopaedic outpatient clinic
with 2 months history of pain and limited range of motion in his
left shoulder. His pain was insidious in onset, mild to moderate in
intensity, aggravated by activities and associated with moderate
rest and night pain. There was no history of direct or indirect
trauma to the left shoulder. Patient was diagnosed as frozen
shoulder at an outside facility and had been given intraarticular
Depomedrol 40 mg injection for the same 40 days ago with no
improvement in his symptoms. He had no fever, chills or rigors. He
had no weight loss or loss of appetite.
He is diabetic and has liver cirrhosis and is on treatment.
On physical examination, the patient was afebrile, B.P was 110/70
mmHg, pulse rate-72beats/min. The skin colour and temperature of
the left shoulder were normal, but the shoulder was tender to touch
over the anterior joint line. Shoulder was very stiff and all shoulder
movements were severely restricted.
MRI was obtained [Fig 2] which showed extraosseous soft tissue
enhancements around left shoulder with soft tissue abscess in inter
muscular planes of supraspinatous, infraspinatous, subscapularis.
glenoid joint effusion with distension of axillary recess.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Blood test revealed normal white cell count with normal
differential count, CRP-13.4 mg/l (normal<5.0 mg/l). The
erythrocyte sedimentation rate was raised, at 88 mm/hour (normal
range,0-20 mm/hour )
Aspiration of shoulder joint was performed and fluid was sent for
aerobic and anaerobic culture, AFB staining, Mycobacterium
culture, and Mycobacterium genetic testing. Aerobic cultures
6.Gelberman RH, Menon J, Austerlitz MS, Weisman MH. Pyogenic arthritis of the shoulder in adults. J Bone Joint Surg Am 1980;62:550-3.5.
7.Leslie BM, Harris JM 3 rd , Driscoll D. Septic arthritis of the shoulder in adults. J Bone Joint Surg Am 1989;71:1516-22.
8. 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.
9.Goldenberg DL, Brandt KD, Cathcart ES, Cohen AS. Acute arthritis caused by gram-negative bacilli: a clinical characterization. Medicine. 1974;53:197–208.
10.Malnick SD, Attali M, Israeli E, Gratz R, Geltner D. Spontaneous bacterial arthritis in a cirrhotic patient. J ClinGastroenterol. 1998;27:364–366.
How to Cite this Article
Sambandam SN, Atturu M. A Case of Septic Arthritis of Shoulder
Presenting as Stiffness of the Shoulder. Journal of Orthopaedic Case