Shoulder Septic Arthritis in a Child: A Diagnostic Dilemma

Septic arthritis of the shoulder in pediatric patients should be diagnosed and treated urgently to prevent complications of the disease. However, early detection can be a challenge due to mild symptoms with ambiguous laboratory and radiological findings. We report a case of an eight-month-old girl who presented to us initially with pseudo paresis of her right shoulder without any signs suggestive of infection. After a negative ultrasound, she was discharged with analgesia upon improvement of range of motion. Three weeks later, she presented with recurrent shoulder pain associated with fever, swelling, elevated CRP, and osteomyelitis changes of the humeral head on a plain radiograph. We proceeded with a minimally invasive arthrotomy washout and commenced on IV antibiotics. At one month follow-up, she regained her full range of motion and recovered fully. No recurrence of septic arthritis until six-month follow-up. This write-up discusses the diagnostic challenge of pediatric shoulder septic arthritis and the surgical technique of minimally invasive arthrotomy washout in a pediatric patient.