title: Non-purulent low-grade infection as cause of pain following shoulder surgery: preliminary results.
abstract: Low-grade infection was systematically searched for in all revision shoulder surgeries by harvesting tissue samples. Ten consecutive patients were identified with a non-purulent low-grade infection of the shoulder. All of these patients suffered from pain and eight were stiff. Preoperative aspiration in eight patients yielded bacterial growth in only one case. Serum C-reactive protein levels were normal in seven out of 10 cases. Propionibacterium acnes was identified in seven, coagulase-negative Staphylococcus in two and Staphylococcus saccharolyticus in one case. The delay between harvesting the tissue samples and detection of bacterial growth averaged eight days (range, 2-17). After debridement and antibiotic treatment for a mean of 4.5 months, tissue samples were repeatedly harvested in nine patients due to persistent pain. The infection was microbiologically eradicated in six out of nine cases that had a repeated biopsy. However, nine out of 10 patients continued to suffer from moderate to severe pain. Low-grade infection of the shoulder can be a cause of persistent pain and stiffness. The results of antibiotic treatment are disappointing. Further studies are necessary to analyse this difficult pathology.
authors.affiliation: Shoulder & Elbow Surgery, Seefeldstr. 27, 8008, Zurich, Switzerland. ags@schulter-ellbogen.ch
authors.forename: Alberto G
authors.initials: AG
authors.lastname: Schneeberger
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gilbart
authors.forename: Ralph
authors.initials: R
authors.lastname: Sheikh
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001182:Arthroscopy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes / Q000302:isolation & purification; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013530:Surgical Wound Infection / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D013585:Synovitis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents