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

Abstract

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.

Level of diagnostic agreement in musculoskeletal shoulder diagnosis between remote and face‐to‐face consultations: A retrospective service evaluation

“… 1 This is echoed by Schutz et al 39 that remote consultations were considered “not fit for purpose” when attempting to make a diagnosis in primary care. The result of mismanaged patients could be a delay in appropriate treatment, poorer patient outcomes 40 and ultimately, higher medicolegal costs for health boards. 41 The literature supports careful consideration be given to more complex patient cases, to have them initially assessed face‐to‐face 4 and for a balance to be struck between remote and face‐to‐face consultations to mitigate against the aforementioned risks.…”