Author(s): Scott F.M. Duncan, MD, MPH*; John W. Sperling, MD, MBA; Mayo Clinic, Phoenix, AZ
Title: Isolated Shoulder Sepsis in the Adult Patient
Purpose: The purpose of this study was to examine the treatment of isolated shoulder sepsis in the adult patient.
Methods: A retrospective chart review was performed of all adult patients who underwent operative treatment of isolated should sepsis at our institution from 1996-2005. Patient age, gender, laboratory studies, previous treatment, surgical procedures, surgical findings, cultured organism, antibiotic treatment, and complications were reviewed
Results: Ninteen patients (20 shoulders) underwent operative treatment of isolated shoulder sepsis during the study period. The average age of the patient was 75.5 years (49-94). All patients initially underwent open debridement through a deltopectoral approach (9 shoulders) or an arthroscopic approach (11 shoulders). All of the patients had evidence of purulent material within the glenohumeral joint at the time of surgery. Five shoulders required repeat procedures to help clear the infection. The offending organisms in our series included: MSSA (6), Strep B- beta hemolytic (5), Staph epi (3), negative cultures (2), Strep viridans (1), E. coli (1), MRSA (1), and Prop. (1). All were treated with an average of 4.2 weeks (range 3-8 weeks) of intravenous antibiotics. Twelve patients were noted to have full thickness rotator cuff tears and 12 were noted to have cartilage loss of the glenohumeral joint. One patient died during his hospitalization for shoulder sepsis.
Discussion: Open or arthroscopic debridement in conjunction with appropriate antibiotics appears to be an effective technique to eradicate infection in most adults who present with shoulder sepsis. In contrary to post-operative shoulder infections which have been found to have Prop. as the most common organism, our results show that Staph and Strep species represent the majority of cases in native shoulder sepsis. The treating physician should be aware that some patients may fail debridement procedures and will go on to require humeral head resection. A majority of patients in this series had irreparable rotator cuff tears, which also makes functional use of the shoulder limited especially when combined with joint cartilage loss. In the rare case, patients may die from complications related to their shoulder sepsis.
