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Injection-induced low-grade infection of the shoulder joint: preliminary results

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Purulent arthritis of the shoulder has been widely reported. Low-grade post-operative infections of the shoulder have also been observed. Low-grade infections of the shoulder without prior surgery have not been reported in the literature. The purpose of this study is to present our experience of seven patients with low-grade infections of the shoulder without a history of prior surgery.

Methods

We retrospectively reviewed seven patients, mean age of 45 years that originally presented with diffuse shoulder pain, with or without stiffness. None had prior surgery but all had prior injections, average 5.6, into the shoulder. All patients were treated with various arthroscopic procedures. All had harvesting of four tissue probes identifying low-grade infection. Pre/post-operative pain score, pre/post-operative range of motion, intraoperative findings, post-operative Constant score, Subjective Shoulder Value and pre/post operative radiographs were analyzed. Post-operative antibiotic therapy was recorded.

Results

All patients showed synovitis without pus or any other sign of infection. Propionibacterium acnes were identified in five, coagulase-negative Staphylococcus in two, and Staphylococcus saccharolyticus in one shoulder. One patient had a mixed infection (Propionibacterium acnes and coagulase-negative Staphylococcus). Therapy consisted of oral antibiotics for 1–6 months. Four patients had a satisfactory and three an unsatisfactory outcome.

Conclusions

Diffuse shoulder pain with or without stiffness in patients without prior surgical history can be caused by low-grade infection. Treatment using oral antibiotics has unpredictable outcomes. Further studies are necessary to analyze this pathology.

Level of evidence

Level IV, retrospective case series, treatment study.

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References

  1. Athwal GS, Sperling JW, Rispoli DM, Cofield RH (2007) Acute deep infection after surgical fixation of proximal humeral fractures. J Shoulder Elbow Surg 16(4):408–412

    Article  PubMed  Google Scholar 

  2. Barzaga RA, Nowak PA, Cunha BA (1991) Escherichia coli septic arthritis of a shoulder in a diabetic patient. Heart Lung J Crit Care 20(6):692–693

    CAS  Google Scholar 

  3. Bertone C, Rivera F, Avallone F, Urgelli S, Maniscalco P (2002) Pneumococcal septic arthritis of the shoulder. Case report and literature review. Panminerva Med 44(2):151–154

    PubMed  CAS  Google Scholar 

  4. Constant CR, Gerber C, Emery RJ, Sojbjerg JO, Gohlke F, Boileau P (2008) A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361

    Article  PubMed  Google Scholar 

  5. Craig JG, van Holsbeeck M, Alva M (2003) Gonococcal arthritis of the shoulder and septic extensor tenosynovitis of the wrist: sonographic appearances. J Ultrasound Med 22(2):221–224

    PubMed  Google Scholar 

  6. Delyle LG, Vittecoq O, Bourdel A, Duparc F, Michot C, Le Loet X (2000) Chronic destructive oligoarthritis associated with Propionibacterium acnes in a female patient with acne vulgaris: septic-reactive arthritis? Arthritis Rheum 43(12):2843–2847

    Article  PubMed  CAS  Google Scholar 

  7. Dodson CC, Craig EV, Cordasco FA et al (2010) Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 19(2):303–307

    Article  PubMed  Google Scholar 

  8. Garcia S, Combalia A, Segur JM (1996) Septic arthritis of the shoulder due to Streptococcus agalactiae. Acta Orthop Belg 62(1):66–68

    PubMed  CAS  Google Scholar 

  9. Gelberman RH, Menon J, Austerlitz MS, Weisman MH (1980) Pyogenic arthritis of the shoulder in adults. J Bone Joint Surg 62(4):550–553

    PubMed  CAS  Google Scholar 

  10. Goldenberg DL (1998) Septic arthritis. Lancet 351(9097):197–202

    Article  PubMed  CAS  Google Scholar 

  11. Gompels BM, Darlington LG (1981) Septic arthritis in rheumatoid disease causing bilateral shoulder dislocation: diagnosis and treatment assisted by grey scale ultrasonography. Ann Rheum Dis 40(6):609–611

    Article  PubMed  CAS  Google Scholar 

  12. Goon PK, O’Brien M, Titley OG (2005) Spontaneous Clostridium septicum septic arthritis of the shoulder and gas gangrene. A case report. J Bone Joint Surg 87(4):874–877

    Article  PubMed  CAS  Google Scholar 

  13. Herrera MF, Bauer G, Reynolds F, Wilk RM, Bigliani LU, Levine WN (2002) Infection after mini-open rotator cuff repair. J Shoulder Elbow Surg 11(6):605–608

    Article  PubMed  Google Scholar 

  14. Holmberg A, Lood R, Morgelin M et al (2009) Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates. Clin Microbiol Infect 15(8):787–795

    Article  PubMed  CAS  Google Scholar 

  15. Jakab E, Zbinden R, Gubler J, Ruef C, von Graevenitz A, Krause M (1996) Severe infections caused by Propionibacterium acnes: an underestimated pathogen in late postoperative infections. Yale j biol med 69(6):477–482

    PubMed  CAS  Google Scholar 

  16. Jeon IH, Choi CH, Seo JS, Seo KJ, Ko SH, Park JY (2006) Arthroscopic management of septic arthritis of the shoulder joint. J Bone Joint Surg 88(8):1802–1806

    Article  PubMed  Google Scholar 

  17. Kwon YW, Kalainov DM, Rose HA, Bisson LJ, Weiland AJ (2005) Management of early deep infection after rotator cuff repair surgery. J Shoulder Elbow Surg 14(1):1–5

    Article  PubMed  Google Scholar 

  18. Leslie BM, Harris JM 3rd, Driscoll D (1989) Septic arthritis of the shoulder in adults. J Bone Joint Surg 71(10):1516–1522

    PubMed  CAS  Google Scholar 

  19. Mansat P, Cofield RH, Kersten TE, Rowland CM (1997) Complications of rotator cuff repair. Orthop clin N Am 28(2):205–213

    Article  CAS  Google Scholar 

  20. Millett PJ, Yen YM, Price CS, Horan MP, van der Meijden OA, Elser F (2011) Propionibacterium acnes infection as an occult cause of postoperative shoulder pain: a case series. Clin Orthop Relat Res 469(10):2824–2830

    Article  PubMed  Google Scholar 

  21. Mirzayan R, Itamura JM, Vangsness CT Jr, Holtom PD, Sherman R, Patzakis MJ (2000) Management of chronic deep infection following rotator cuff repair. J Bone Joint Surg 82-A(8):1115–1121

    PubMed  CAS  Google Scholar 

  22. Morman M, Fowler RL, Sanosky B, Higgins LD (2011) Arthroscopic tissue biopsy for evaluation of infection before revision arthroplasty. J Shoulder Elbow Surg 20(3):e15–e22

    Article  PubMed  Google Scholar 

  23. Morrey BF, Fitzgerald RH, Kelly PJ, Dobyns JH, Washington JA 2nd (1977) Diphtheroid osteomyelitis. J Bone Joint Surg 59(4):527–530

    PubMed  CAS  Google Scholar 

  24. Pfeiffenberger J, Meiss L (1996) Septic conditions of the shoulder—an up-dating of treatment strategies. Arch Orthop Trauma Surg 115(6):325–331

    Article  PubMed  CAS  Google Scholar 

  25. Resnik CS (1992) Septic arthritis: a rare cause of drooping shoulder. Skeletal Radiol 21(5):307–309

    Article  PubMed  CAS  Google Scholar 

  26. Rhee YG, Cho NS, Kim BH, Ha JH (2008) Injection-induced pyogenic arthritis of the shoulder joint. J Shoulder Elbow Surg 17(1):63–67

    Article  PubMed  Google Scholar 

  27. Sadat-Ali M (1991) Septic arthritis of the shoulder in adults. J Bone Joint Surg 73(1):154

    PubMed  CAS  Google Scholar 

  28. Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL (2009) Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg 91(8):1949–1953

    Article  PubMed  Google Scholar 

  29. Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg 65(4):456–460

    PubMed  CAS  Google Scholar 

  30. Sanders TR, Staple TW (1983) Percutaneous catheter drainage of septic shoulder joint. Radiology 147(1):270–271

    PubMed  CAS  Google Scholar 

  31. Schaeverbeke T, Lequen L, de Barbeyrac B et al (1998) Propionibacterium acnes isolated from synovial tissue and fluid in a patient with oligoarthritis associated with acne and pustulosis. Arthritis Rheum 41(10):1889–1893

    Article  PubMed  CAS  Google Scholar 

  32. Schneeberger AG, Gilbart MK, Sheikh R, Gerber C, Ruef C (2009) Non-purulent low-grade infection as cause of pain following shoulder surgery: preliminary results. Chir Organi Mov 93(Suppl 1):S71–S77

    PubMed  Google Scholar 

  33. Settecerri JJ, Pitner MA, Rock MG, Hanssen AD, Cofield RH (1999) Infection after rotator cuff repair. J Shoulder Elbow Surg 8(1):1–5

    Article  PubMed  CAS  Google Scholar 

  34. Stutz G, Kuster MS, Kleinstuck F, Gachter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8(5):270–274

    Article  PubMed  CAS  Google Scholar 

  35. Sulkowski MS, Abolnik IZ, Morris EI, Granger DL (1994) Infectious arthritis due to Propionibacterium acnes in a prosthetic joint. Clin Infect Dis 19(1):224–225

    Article  PubMed  CAS  Google Scholar 

  36. Tafin UF, Corvec S, Betrisey B, Zimmerli W, Trampuz A (2012) Role of rifampin against Propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model. Antimicrob Agents Chemother 56(4):1885–1891

    Article  CAS  Google Scholar 

  37. Ward WG, Goldner RD (1994) Shoulder pyarthrosis: a concomitant process. Orthopedics 17(7):591–595

    PubMed  CAS  Google Scholar 

  38. Wick M, Muller EJ, Ambacher T, Hebler U, Muhr G, Kutscha-Lissberg F (2003) Arthrodesis of the shoulder after septic arthritis. Long-term results. J Bone Joint Surg 85(5):666–670

    CAS  Google Scholar 

  39. Wilkins J, Patzakis MJ (1990) Peripheral teflon catheters. Potential source for bacterial contamination of orthopedic implants? Clin Orthop Relat Res 254:251–254

    Google Scholar 

  40. Yian EH, Ramappa AJ, Arneberg O, Gerber C (2005) The Constant score in normal shoulders. J Shoulder Elbow Surg 14(2):128–133

    Article  PubMed  Google Scholar 

  41. Zappe B, Graf S, Ochsner PE, Zimmerli W, Sendi P (2008) Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge. Arch Orthop Trauma Surg 128(10):1039–1046

    Article  PubMed  Google Scholar 

  42. Zeller V, Ghorbani A, Strady C, Leonard P, Mamoudy P, Desplaces N (2007) Propionibacterium acnes: an agent of prosthetic joint infection and colonization. J infect 55(2):119–124

    Article  PubMed  Google Scholar 

  43. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl j med 351(16):1645–1654

    Article  PubMed  CAS  Google Scholar 

  44. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE (1998) Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-body infection (FBI) study group. JAMA 279(19):1537–1541

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Endoclinic Zurich, Klinik Hirslanden, Witellikerstr. 40, 8032, Zurich, Switzerland

    Alberto G. Schneeberger

  2. Southern California Permanente Medical Group, Anaheim, CA, USA

    Edward Yian

  3. O N Z, Orthopädisch-Neurochirurgisches Zentrum, Recklinghausen, Germany

    Wolfram Steens

Authors
  1. Alberto G. Schneeberger
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  2. Edward Yian
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  3. Wolfram Steens
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Correspondence to Alberto G. Schneeberger.

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Schneeberger, A.G., Yian, E. & Steens, W. Injection-induced low-grade infection of the shoulder joint: preliminary results. Arch Orthop Trauma Surg 132, 1387–1392 (2012). https://doi.org/10.1007/s00402-012-1562-z

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