Diagnostic management for acute septic arthritis of the shoulder joint

Introduction: It is generally accepted that septic conditions of the should er often lead to an earnest situation with joint damage. Because of the low incidence of shoulder infections there are only a few cases reported in th e literature. Therefore, unlike joint infections of the knee no diagnostic and therapeutic standard procedure is documented for the shoulder. Material s and Methods: In a retrospective study the results of 15 patients with a s urgical revision at the BG-Clinic-Bergmannsheil-Bochum between 1 January 19 89 and 31 August 1999 after an infection of the shoulder joint were analyze d. We registered the following parameters: etiology, intervall until the fi rst clinical symptoms, clinical signs, diagnostic procedure, intraoperative site (Gachter classification), and operative treatment. The diagnostic pro cedure followed an algorithm, including CRP-determination, ultrasound of th e shoulder, ultrasound-guided aspiration and a Gram stain. If the result wa s positive, surgical joint revision followed. The infection stage was class ified intraoperatively according to the criteria of the Gachter classificat ion. Eight patients were reexaminated after an average follow-up of 4.8 yea rs. Results: Fourteen infections followed injection. All patients demonstra ted increasing CRP levels and a painful limited range of motion. In all Gra m stains we detected bacterial organisms. The diagnosis of an acute infecti on according to the criteria of this diagnostic algorithm was verified intr aoperatively in all 15 joints. Two patients with delayed admission died pos toperatively due to septic multiorgan failure despite maximal treatment und er intensive care conditions. Conclusion: If there are suspicious clinical symptoms after a typical anamnesis, we recommend an immediate diagnostic al gorithm, including CRP determination, ultrasound of the shoulder, ultrasoun d-guided joint puncture and a Gram stain. If there is acute joint infection , time-consuming diagnostic procedures must be avoided because of the risk of secondary reduced joint mobility or life-threatening complications.