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Arch Orthop Trauma Surg 1996;115(6):325-331

1. Septic conditions of the shoulder--an up-dating of treatment strategies.

Pfeiffenberger J, Meiss L

Department of Traumatology, Teaching Hospital of the Humboldt University of Berlin, Germany.

We report the cases of 28 patients with bacterial infections of the shoulder treated between 1979 and 1991. There were ten cases of septic arthritis, ten cases of simple osteomyelitis of the proximal humerus, four cases of septic arthritis and concomitant osteomyelitis of the proximal humerus and four cases of periarticular soft-tissue infection. The infections, except for the cases of osteomyelitis, were staged by a "Classification of Exogenic Bacterial Infections" (CEBI). In septic arthritis and in periarticular soft-tissue infection, the time between the initial symptoms of infection and diagnosis was about 20 days. In the cases with osteomyelitis, there was an average delay of 9 months, which was partly due to the slow evolution of plasmacellular osteomyelitis. Treatment was based on operative debridement and arthrotomy, the insertion of drains, the implantation of gentamicin-polymethylmethacrylate beads and the application of high-dose parenteral antibiotics. In the postoperative period physi otherapy with early active and/or passive range-of-motion exercises favoured the draining of secretions and therefore gave better results than complete immobilisation. Treatment was evaluated using a modification of the shoulder score of Wulker et al. [17]. This study demonstrated that favourable results could only be obtained if the diagnosis was made early. This is particularly true for infections with Staphylococcus aureus (found in 19 patients). The overall result of the treatment of osteomyelitis and periarticular soft-tissue infection was good or satisfactory, while unsatisfactory results were noted for the patients with septic arthritis, particularly those with both septic arthritis and osteomyelitis.

 

J Bone Joint Surg [Am] 1980;62(4):550-553

2. Pyogenic arthritis of the shoulder in adults.

Gelberman RH, Menon J, Austerlitz MS, Weisman MH

The cases of fifteen patients with sixteen septic glenohumeral joints were evaluated. In each of the patients there was at least one predisposing factor, and each patient was treated by either repeated aspiration (eleven shoulders) or arthrotomy (five shoulders), combined with parenteral antibiotics. The most significant factors leading to poor results of treatment were delay in instituting treatment, virulence of the infecting organism, and a serious underlying disease process. In eight of ten shoulders in which treatment was begun four weeks or less after symptoms appeared, a satisfactory functional outcome was obtained, while all six patients who were treated after a delay of more than four weeks had poor results. All six patients infected with Streptococcus or coagulase-negative Staphylococcus had satisfactory results. Two of the eight patients with Staphylococcus aureus or gram-negative organisms also had a satisfactory result, while the other six did not. The two successfully treated patients with Sta phylococcus aureus were diagnosed within three days of the onset of symptoms, whereas the others had delays in instituting treatment.

 

J Bone Joint Surg [Am] 1989 Dec;71(10):1516-1522

3. Septic arthritis of the shoulder in adults.

Leslie BM, Harris JM 3d, Driscoll D

Department of Orthopaedic Surgery, New England Medical Center, Boston, Massachusetts 02111.

Septic arthritis of the shoulder is uncommon in adults. We reviewed the cases of eighteen patients who were followed for a minimum of one year. The patients ranged in age from forty-two to eighty-nine years. All but one patient had at least one serious associated disease. Eight patients had had an injection or aspiration of the shoulder before development of the infection. All but one patient had had a delay in diagnosis. At the time of admission to the hospital, the erythrocyte sedimentation rate was always elevated, but the body temperature and white blood-cell count were not. After treatment, the functional result was usually poor: only five patients regained forward flexion to 90 degrees or more, eight patients had no active motion of the glenohumeral joint, and two patients died. Arthrotomy appeared to afford a better result than did repeated aspiration.

 

Arthritis Rheum 1977 Nov;20(8):1500-1506

4. Septic arthritis of the glenohumeral joint. Unique clinical and radiographic features and a favorable outcome.

Master R, Weisman MH, Armbuster TG, Slivka J, Resnick D, Goergen TG

Seven patients (eight shoulders) with sepsis of the glenohumeral joint were studied clinically and radiographically. Despite the advanced age of the patients, the presence of gram-negative organisms, and multiple risk factors in each patient (including serious chronic underlying diseases), needle drainage and parenteral antibiotics were all that were required for successful management, provided early diagnosis with prompt institution of antibiotics and drainage occurred. Contrast arthrography safely guided therapy and revealed rotator cuff tears in four of six shoulders as well as frequent extra-articular extensions of the disease. A nonleukemic patient with Aeromonas hydrophilia sepsis and arthritis is reported who survived with eradication of infection and preservation of joint function. A poor prognosis for shoulder sepsis is not substantiated.

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