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Septic shoulders in children
Insights
Septic arthritis of the glenohumeral joint is common in infants. Early diagnosis and surgical intervention, including arthrotomy and bone decompression, are crucial for effective treatment in children.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Pediatric Rheumatology
Background:
- Septic arthritis of the glenohumeral joint is a serious condition in children.
- Early diagnosis and treatment are essential to prevent long-term joint damage.
Purpose of the Study:
- To review the clinical characteristics, diagnostic findings, and treatment outcomes of pediatric patients with septic arthritis of the glenohumeral joint.
- To evaluate the effectiveness of surgical management, including arthrotomy and bone decompression.
Main Methods:
- Retrospective review of nine pediatric patients diagnosed and treated for septic arthritis of the glenohumeral joint.
- Analysis of clinical presentation, laboratory findings, radiographic evidence, microbiological data, and treatment strategies.
Main Results:
- Eight of nine patients were under 18 months of age.
- Common findings included elevated white blood cell count, fever, elevated sedimentation rate, and joint space widening on radiographs.
- Osteomyelitis of the proximal humerus was present in five patients.
- Joint cultures identified various organisms.
Conclusions:
- Septic arthritis of the glenohumeral joint in children often presents in infants and can be associated with osteomyelitis.
- Prompt diagnosis via aspiration followed by surgical management, including arthrotomy and decompression, is recommended.
Abstract:
A review was carried out on nine children who were diagnosed and treated for septic arthritis of the glenohumeral joint at the University of California, San Diego affiliated hospitals. Eight of the nine patients were under 18 months of age at the time of diagnosis. Three patients had a history of antecedent trauma, and four had a previous or concurrent source of infection. The longest delay between the onset of symptoms and diagnosis was 30 days with the majority being diagnosed within 4 days of onset. Laboratory findings revealed a mean white blood cell count of 17,400 and a mean temperature of 39.3 degrees C. The sedimentation rate was always greater than 30 mm and averaged nearly 60 mm in these nine patients. Joint cultures were positive for a variety of organisms. Early radiographic findings often demonstrated widening of the joint space. Associated osteomyelitis of the proximal humerus was present in five of nine patients. Once the diagnosis has been established by aspiration, we recommend arthrotomy. Important aspects of the surgery include drainage of the joint and bicipital recess, and drilling of the proximal humeral metaphysis to rule out osteomyelitis or to more adequately decompress the bone.