[The diagnostic concept of acute infection of the shoulder joint].
BACKGROUND
It is generally accepted that septic conditions of the shoulder often lead to an earnest situation with joint damage. Because of the low incidence of shoulder infections there are only a few cases reported in the literature. Therefore, unlike joint infections of the knee no diagnostic and therapeutic standard procedure is documented for the shoulder.


METHODS
In a retrospective study the results of 15 patients with a surgical revision at the BG-Clinic-Bergmannsheil-Bochum between 1 January 1989 and 31 August 1999 after an infection of the shoulder joint were analyzed. We registered the following parameters: etiology, intervall until the first clinical symptoms, clinical signs, diagnostic procedure, intraoperative site (Gächter classification), and operative treatment. The diagnostic procedure followed an algorithm, including CRP-determination, ultrasound of the shoulder, ultrasound-guided aspiration and a Gram stain. If the result was positive, surgical joint revision followed. The infection stage was classified intraoperatively according to the criteria of the Gächter classification. Eight patients were reexamined after an average follow-up of 4.8 years.


RESULTS
Fourteen infections followed injection. All patients demonstrated increasing CRP levels and a painful limited range of motion. In all Gram stains we detected bacterial organisms. The diagnosis of an acute infection according to the criteria of this diagnostic algorithm was verified intraoperatively in all 15 joints. Two patients with delayed admission died postoperatively due to septic multiorgan failure despite maximal treatment under intensive care conditions.


CONCLUSIONS
If there are suspicious clinical symptoms after a typical anamnesis, we recommend an immediate diagnostic algorithm, including CRP determination, ultrasound of the shoulder, ultrasound-guided joint puncture and a Gram stain. If there is acute joint infection, time-consuming diagnostic procedures must be avoided because of the risk of secondary reduced joint mobility or life-threatening complications.
Ambacher
T
T
Unfallchirurgische Klinik, Katharinenhospital Stuttgart. ThAmbacher@t-online.de
Esenwein
S
S
Kollig
E
E
Muhr
G
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000465:Algorithms; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D001182:Arthroscopy; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D001431:Bacteriological Techniques; D002097:C-Reactive Protein / Q000032:analysis; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000382:microbiology / Q000601:surgery; D014463:Ultrasonography
D002097:C-Reactive Protein