Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Sepsis or Infection
Glenohumeral joint sepsis is an unusual indication for shoulder arthroscopy. Arthroscopy has greatly facilitated the management of this difficult condition. Treatment goals include acquiring fluid cultures and tissue biopsies to identify the infecting organism or organisms and determining the extent of tissue involvement, followed by joint irrigation and débridement in a manner that minimizes morbidity and allows early functional recovery. Serial needle aspirations cannot remove all joint debris or reach all loculations and infected clots. Arthrotomy enables thorough irrigation and débridement, but with increased soft tissue injury compared with arthroscopic treatment.
Literature Review
Most series on sepsis in various joints report the incidence of shoulder involvement as 3% to 12%. The most common organisms isolated are Staphylococcus aureus (61%) and Staphylococcus epidermidis (17%), but polymicrobial infections are frequent (67%). In his series, Gelberman noted that all patients had significant underlying medical conditions, such as alcoholism, liver disease, malignancy, heroin addiction, or renal failure. Patients with acquired immunodeficiency syndrome and patients who have undergone shoulder replacement may also present with septic shoulders. The rise of methicillin-resistant S. aureus and Propionibacterium acnes is of concern. The latter is very difficult to detect with laboratory analysis.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here