Extra-Articular Abscess Expansion as a Specific Complication of Septic Arthritis of the Shoulder Joint: Report of Three Cases with Extension of the Infection through the Biceps Groove Producing a Large Abscess

Abstract

Background: Septic arthritis of shoulder is a rare clinical entity as the metaphysis is extracapsular and there is no communication between epiphyseal and metaphyseal vessels. Septic arthritis of the shoulder joint is a diagnostic and surgical emergency because joint destruction develops rapidly and can cause significant morbidity and mortality. Unusual complications of septic arthritis of the shoulder joint may include extra-articular abscess extension to the upper arm through the biceps groove and osteomyelitis of the greater tuberosity.

Case Presentation: Septic arthritis of the shoulder, if left untreated, can lead to complications such as extra-articular abscess extension and osteomyelitis. Three patients with septic arthritis of the shoulder joint with no clear history of trauma were reported in this study. The initial presentation was pseudoparalysis with upper arm swelling. MRI diagnosed septic arthritis of shoulder joint together with an upper arm abscess. Arthroscopic debridement with through irrigation and open drainage of the extra-articular abscess extension to the upper arm improved both the shoulder pain and abscess completely. However, if shoulder pain or abnormalities in laboratory findings continue after initial treatment, uncontrolled septic arthritis or secondary osteomyelitis are possibilities that should be concerned. MRI is a useful tool for detecting those atypical complications.

Conclusions: Rarely, septic arthritis of the shoulder joint can extend to the upper arm through the biceps tendon groove and cause an abscess. Also, acute osteomyelitis of the tuberosity should be considered in patients with long-standing refractory septic arthritis of the shoulder joint who have continued pain and uncontrolled laboratory findings after initial treatment.

Keywords

Abscess / Arm / Arthritis / Infectious / Osteomyelitis / Shoulder Joint

References

[1] Jiang JJ, Piponov HI, Mass DP, Angeles JG, Shi LL. Septic arthritis of the shoulder: acomparison of treatment methods. J Am Acad Orthop Surg. 2017; 25: e175–e184.

[2] Williams RJ 3rd, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med. 1997; 25: 261–267.

[3] Mathews CJ, Coakley G. Septic arthritis: current diagnostic and therapeutic algorithm. Curr Opin Rheumatol. 2008; 20: 457–462.

[4] Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M, et al. Management of septic arthritis: a systematic review. Postgrad Med J. 2008; 84: 265–270.

[5] Parisien JS, Shaffer B. Arthroscopic management of pyarthrosis. Clin Orthop Relat Res. 1992; 275: 243–247.

[6] Montgomery SC, Campbell J. Septic arthritis following arthroscopy and intra-articular steroids. J Bone Joint Surg Br. 1989; 71: 540.

[7] Rhee YG, Cho NS, Kim BH, Ha JH. Injection-induced pyogenic arthritis of the shoulder joint. J Shoulder Elbow Surg. 2008; 17: 63–67.

[8] Stutz G, Kuster MS, Kleinstuck F, Gächter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc. 2000; 8: 270–274.

[9] Abdel MP, Perry KI, Morrey ME, Steinmann SP, Sperling JW, Cass JR. Arthroscopic management of native shoulder septic arthritis. J Shoulder Elbow Surg. 2013; 22: 418–421.

[10] Bohler C, Pock A, Waldstein W, Staats K, Puchner Johannes Holinka SE, et al. Surgical treatment of shoulder infections: a comparison between arthroscopy and arthrotomy. J Shoulder Elbow Surg. 2017; 26: 1915–1921.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.