Dorsal subscapularis approach for the surgical drainage of subscapularis intramuscular abscess: a case report

Abstract

Background Abscess formation in the subscapularis muscle is a rare clinical condition. Few reports are available regarding the treatment methods and surgical approaches for subscapularis intramuscular abscesses. Here, we describe a case of subscapularis intramuscular abscess that was treated successfully via surgical drainage using a new approach, the “dorsal subscapularis approach”. Case presentation A 67-year-old woman presented to our hospital with complaints of fever and disturbance of consciousness. Two days prior to visiting our hospital, right shoulder pain and limited range of motion in the shoulder were noted. Cerebrospinal fluid examination and contrast-enhanced computed tomography (CT) imaging on admission revealed a right subscapularis intramuscular abscess with concomitant bacterial meningitis. The patient’s clinical symptoms improved after antibiotic administration for 3 weeks, but the right shoulder pain persisted. Contrast-enhanced CT imaging performed after antibiotic administration revealed an abscess in the right shoulder joint space, in addition to a capsule of the abscess in the right subscapularis muscle. We performed open surgical drainage for the abscess, which had spread from the subscapularis muscle to the glenohumeral joint. Using the deltoid-pectoral approach, we detected exudate and infected granulation tissue in the joint cavity. Furthermore, we separated the dorsal side of the subscapularis muscle from the scapula using a raspatory and detected infected granulation tissue in the subscapularis muscle belly. We performed curettage and washed as much as possible. After surgery, antibiotic administration continued for 2 weeks. The patient’s right shoulder pain subsided and CT performed 2 months after surgery revealed no recurrence of infection. Conclusions The present case indicated that a subscapularis intramuscular abscess could lead to severe concomitant infections of other organs via the hematogenous route. Thus, early detection and treatment are necessary. Moreover, in this case, surgical drainage using a dorsal subscapularis approach was beneficial to treating the abscess, which had spread from the subscapularis muscle to the glenohumeral joint.

Spontaneous Intramuscular Abscesses Involving the Rotator Cuff Muscles in Two Cases Presenting During the COVID-19 Pandemic

“…We note that multiple approaches to access the subscapular space have been described. Patel et al and Furuhata et al both utilised the same approach to access the subscapular space [ 7 , 9 ]. Furuhata et al also subsequently describe accessing the dorsal side of the subscapularis muscle belly to reduce the risk of neurovascular injury and pneumothorax [ 9 ].…”

“…Patel et al and Furuhata et al both utilised the same approach to access the subscapular space [ 7 , 9 ]. Furuhata et al also subsequently describe accessing the dorsal side of the subscapularis muscle belly to reduce the risk of neurovascular injury and pneumothorax [ 9 ]. The benefit of the deltoid-pectoral approach is that it enables access to both the subscapular space and glenohumeral joint.…”

Isolated spontaneous biceps abscess causing septic shock in a diabetic patient: A rare case report

“…In such circumstances needle aspiration may confirm the diagnosis, but in our case, given the patient’s haemodynamic instability, immediate surgical drainage was performed. Predisposing conditions include immunocompromised states such as diabetes, malignancy, intravenous drug use, or HIV [ 6 ]. There have also been isolated reports of patients with gonococcal septicaemia and tuberculosis presenting with an abscess in their biceps [ 1 , 4 ].…”

A rare case of isolated post-traumatic subscapularis abscess in a paediatric patient

“…A child presents with a shoulder swelling is always a diagnostic challenge for clinicians. [1][2][3][4][5][6][7][8][9] The differentials vary from fractures, dislocations, bone or soft tissue tumor and infection. A subscapular abscess is often diagnosed late.…”

“…High index of suspicion for early detection is paramount as patient can have rapid deterioration. 1,6,7 Early detection is important as literatures reported deaths and hematogenous spread to lungs and brain leading to pneumoniae and bacterial meningitis. 1,6,7 Most the previous reported cases described the abscess located in the subscapularis muscle with extension to the glenohumeral or subscapular space with or without concurrent lung or brain infection.…”