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Published on: November 17, 2023
Secondary frozen shoulder following septic arthritis - An unusual complication of magnetic resonance arthrogram
Aysha Rajeev1, Adrian Andronic2, Abdalla Mohamed2
1Associate Specialist Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK.
Introduction:
Magnetic resonance (MR) arthrogram is a commonly used investigation tool to detect various pathologies in the shoulder. The complications following this procedure is minor and rare. Septic arthritis is one of the rare complications which can develop after MR arthrogram. We report a case of secondary frozen shoulder after MR arthrogram induced septic arthritis.
Presentation Of Case:
A young, fit and well female patient underwent MR arthrogram to detect any labral tears. Two days following the procedure, she developed signs and symptoms suggestive of septic arthritis of the shoulder. The patient underwent repeated arthroscopic debridement and washout. The organisms isolated was Staphylococcus epidermidis. She was treated with six weeks of intravenous antibiotics. The patient developed stiffness of the shoulder due to secondary frozen shoulder which was treated with arthroscopic capsular release with good functional outcomes at three months.
Discussion:
MR arthrogram is a rare cause of septic arthritis of the shoulder. The common method introducing the organisms is from the skin flora or contaminated arthrogram trays. The treatment is repeated arthroscopic washouts and six weeks of appropriate intravenous antibiotics. Residual pain, stiffness and chondrolysis are common sequelae of septic arthritis.
Conclusion:
Septic arthritis is a recognised and rare complication of MR arthrogram. Early and prompt diagnosis with arthroscopic washout and debridement combined with intravenous antibiotics helps to eradicate the infection. Secondary frozen shoulder is a late complication of sepsis in the joint.
Insights
Magnetic resonance (MR) arthrogram can rarely lead to septic arthritis, a serious shoulder infection. Prompt treatment with antibiotics and surgery is crucial, though secondary frozen shoulder can be a late complication.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Radiology
Background:
- Magnetic resonance (MR) arthrogram is a common diagnostic tool for shoulder pathologies.
- Complications are typically minor and rare.
- Septic arthritis is an infrequent but serious complication following MR arthrogram.
Purpose of the Study:
- To report a case of secondary frozen shoulder after MR arthrogram-induced septic arthritis.
- To highlight the diagnostic and management challenges of this rare complication.
Main Methods:
- A case presentation of a young female patient who developed septic arthritis post-MR arthrogram.
- Treatment involved repeated arthroscopic debridement, intravenous antibiotics (Staphylococcus epidermidis identified), and subsequent arthroscopic capsular release for frozen shoulder.
Main Results:
- The patient developed septic arthritis two days after the procedure.
- Successful eradication of infection with antibiotics and surgical washout.
- Resolution of secondary frozen shoulder with arthroscopic capsular release, achieving good functional outcomes at three months.
Conclusions:
- MR arthrogram is a rare cause of shoulder septic arthritis, often due to skin flora contamination.
- Early diagnosis and prompt treatment (arthroscopic washout, debridement, antibiotics) are vital.
- Secondary frozen shoulder is a potential late sequela of joint sepsis.
