Septic arthritis and arthropathy of the rotator cuff: remember this association

Sobreira, Danilo; Souza, N. de; Almeida, José Inácio de; Pochini, Alberto de Castro; Andreoli, Carlos Vicente; Ejnisman, Benno

doi:10.1016/j.rboe.2015.09.016

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…But it is worth noting that the patient in this study did not develop a local infection after intramuscular injection. Danilo et al reported 7 patients with rotator cuff tear developing shoulder joint infection without trauma or surgery of shoulder [ 30 ]. Nonetheless, despite the absence of evidence, their report cannot clarify the relationship between rotator cuff tears and infection.…”

Section: Discussionmentioning

confidence: 99%

Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review

Huang

Liu

et al. 2021

BMC Infect Dis

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Background Enterobacter cloacae (E. cloacae) is one of the commensal flora in the human intestinal tract and a prevalent nosocomial pathogen, which rarely causes infectious osteoarthritis in immunocompetent patients without recent trauma or surgery. Here, we report the first case of septic monoarthritis of the shoulder caused by E. cloacae in an immunocompetent patient. Case presentation A 52-year-old female with a 6-year history of right shoulder pain was referred to our emergency department due to fever, acute severe shoulder pain, and swelling. Blood test showed elevated inflammatory markers. The patient denied any recent invasive surgical procedure and trauma. She was misdiagnosed with a frozen shoulder, and the anti-inflammatory painkiller celecoxib for symptomatic treatment was ineffective. Magnetic resonance imaging (MRI) showed a shoulder joint abscess and supraspinatus tendon tear. The joint aspirate culture showed E. cloacae. After late diagnosis, she was treated with levofloxacin and underwent surgical debridement and irrigation. Her follow-up data revealed that she did not suffer from shoulder swelling and severe pain. Conclusion This is a rare case of E. cloacae infected arthritis of the shoulder in an immunocompetent patient with a rotator cuff tear, indicating that even if the symptoms and age of the patients match the characteristics of frozen shoulder, the possibility of septic arthritis should be considered in the presence of fever and increasing inflammatory markers. The cases of our literature review suggest that the patients subjected to invasive procedure may develop a subsequent E. cloacae osteoarticular infection, regardless of being asymptomatic after the procedure.

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Section: Discussionmentioning

confidence: 99%

Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review

Huang

Liu

et al. 2021

BMC Infect Dis

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Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review

Salazar¹,

Gutierrez-Naranjo

Meza³

et al. 2022

BMC Musculoskelet Disord

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Background Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is frequently a missed or delayed diagnosis. Reliance on aspiration and serum markers has been called into question recently. The purpose of this study was to conduct a systematic review investigating the value of joint aspiration and serum markers in the diagnosis of native shoulder joint sepsis. Methods PubMed/MEDLINE, Scopus, and the Cochrane Library were used in the systematic literature search from January 1, 1960, through January 23, 2021. The primary outcome was to report on the synovial white cell count of patients with native shoulder sepsis. Descriptive statistics using percentages, means, and intraclass correlation coefficient (ICC) values were used to summarize the results. Results Thirty-one studies, including 25 case series, one case-control, and five cohort studies with a total of 7434 native shoulder joints, were included. There was no standardized approach to diagnosing septic arthritis of the shoulder. Only 10 studies (32%) reported on synovial white cell count with the majority yielding aspiration counts greater than 50,000 cells/mm3, although one study was as low as 30,000 cells/mm3. Conclusions The diagnosis of native shoulder joint sepsis lacks uniformity. Methods used to evaluate shoulder sepsis are heterogeneous and may lead to delays or misdiagnosis with devastating sequelae. Synovial white cell count is underutilized and may also present with a lower value than expected, which is likely related to the time interval between symptom onset and diagnosis.

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Septic arthritis and arthropathy of the rotator cuff: remember this association

Cited by 2 publications

References 13 publications

Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review

Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review

Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review

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