Novel Approach to Periscapular Abscesses in a 2-Year-Old: A Case Report

We aim to present a novel approach to decompression of a periscapular abscess in the pediatric patient.

We present a 2-year-old male transferred to a Level 1 pediatric trauma center (PTC) from outside hospital (OSH) with MRSA positive blood cultures in sepsis. Before presentation to the OSH, the patient had several days of right upper arm pain with any movement and developed a fever the day before. Magnetic resonance imaging (MRI) of the right shoulder at PTC revealed subscapularis and supraspinatus abscesses. Utilizing a modified Judet approach, the supraspinatus abscess was directly decompressed. Through the same approach, a corticotomy of the scapular body was performed with a high-speed burr, and the subscapularis abscess was indirectly decompressed. Two drains were placed, and appropriate antibiotic therapy continued.

The patient was discharged on postoperative day 3 after transition to oral antibiotics by infectious disease. The patient was followed up in pediatric clinic on postoperative day 15 without recurrence of infection and with full painless range of motion. At that time, the incision was well healed without drainage or erythema. The patient was continued on oral Bactrim for two more weeks. To date, the patient has had no recurrence.

We present a viable option for decompression of periscapular abscesses in the young pediatric population when traditional approaches such as deltoid split or deltopectoral would not be possible given the altered anatomy of the young and immature patients.