Pathological unstable dislocation of shoulder secondary to septic arthritis: A case report

Abstract

Introduction: Pathological unstable dislocation of the glenohumeral joint following septic arthritis is a rare condition. We report a case of 40 years old patient with pathological shoulder dislocation secondary to septic arthritis.

Case presentation: A 40 years old male patient presented to the Department of Orthopedics with chief complain of swelling and pain of Right upper extremity for 6 days. He had history of IV canula insertion to give fluids. Then he developed swelling of hand which progressively increased up to right shoulder. He also complained of severe pain over that region. X-ray showed anteromedial dislocation of humeral head. Aspiration of joint was done and the aspirate was sent for culture and sensitivity, which revealed Staphylococcus aureus. Incision and drainage was performed, about 500 ml of straw-colored pus mixed with synovial fluid extending up to sternum, posteriorly up to clavicle and laterally up to deltoid was estimated. Then we planned for open reduction and percutaneous pinning with K-wire. The intervention led to substantial loss of disability and regain of limited range of motion.

Discussion: Septic Arthritis in adults is uncommon and complete dislocation of the glenohumeral joint associated with it is rare. Septicemia was a common complication among all treatment groups, with cultures most frequently indicating Staphylococcus aureus as the causative organism. Septic arthritis is most commonly caused by hematogenous but recently, the incidence of hematogenous septic arthritis has decreased, while local injection-induced septic arthritis has been increased specially in shoulder.

Conclusion: Septic arthritis of the glenohumeral joint is rare condition in comparison with knee and hip joints. Therefore, the diagnosis requires a high index of suspicion, early evaluation and treatment of the affected shoulder. Our case is a good example of how we can use simple surgery techniques like open reduction and percutaneous fixation with K-wire in low and middle income countries where patient is not economically sound to afford arthroplasty.

Keywords: Adult; Septic arthritis; Shoulder dislocation.