Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection

Skedros, John G.; Henrie, Marshall K; Finlinson, Ethan D.; Trachtenberg, Joel D.

doi:10.1136/bcr-2018-226598

Cited by 4 publications

(3 citation statements)

References 48 publications

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“…The close proximity (five weeks) of our patient’s subacromial corticosteroid injection to his open RCR may have increased the risk of postoperative infection. This supposition is based on anecdotal and retrospective observations [ 7 , 37 ]. However, a study of 12,060 patients who had a shoulder corticosteroid injection within one year of arthroscopic RCR on the same shoulder found that the risk of infection was significantly increased only when the injection is given within one month of the surgery [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Schaalia (Formerly Actinomyces) turicensis Infection Following Open Rotator Cuff Repair

Cronin¹,

Richards²,

Skedros³

2023

Cureus

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We report the case of a male in his early 70s who developed a deep infection after an open rotator cuff repair, with Schaalia turicensis as the only organism isolated from a surgical biopsy of the tendon remnants and phlegmatic/purulent material at the failed repair site. This species was originally within the genus Actinomyces. We report this case because it is the only one that we could locate where an infected open rotator cuff repair site grew S. turicensis. Our patient was not diabetic, did not smoke, and did not have other recent or concurrent infections. He had hypertension, hypothyroidism, depression, and a hyperactive bladder. Hence, he only had minor risk factors for infection. His postoperative shoulder infection was eradicated with surgical irrigation and debridement, and 6.5 weeks of primarily oral antibiotic treatment. We also review the literature on infections after any shoulder surgery where Schaalia or Actinomyces species were isolated.

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Section: Discussionmentioning

confidence: 99%

Schaalia (Formerly Actinomyces) turicensis Infection Following Open Rotator Cuff Repair

Cronin¹,

Richards²,

Skedros³

2023

Cureus

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“…The most commonly isolated pathogen from abscesses is Staphylococcus aureus , as was the case in both of our patients. There are several hypothesised aetiologies that can result in abscess formation; the causative organisms may enter the tissue by direct implantation (e.g., a penetrating injury with a contaminated object) [ 6 ] or secondary to trauma [ 2 , 7 ]. They may also enter tissue by direct migration from a location where there is resident flora into an adjacent, normally sterile area because natural barriers have been disrupted (e.g., an area of cellulitis).…”

Section: Discussionmentioning

confidence: 99%

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

East¹,

Piper²,

Chan³

2020

Cureus

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Spontaneous abscesses involving the rotator cuff muscles are a rare surgical occurrence. Patients with such abscesses are often initially misdiagnosed or there is a significant diagnostic delay. Herein, we report one case of a spontaneous intramuscular abscess involving the subscapularis muscle and a second case of an abscess involving the supraspinatus muscle. There is a multitude of predisposing risk factors to developing an intramuscular abscess formation, which includes immunodeficiency, trauma, injection drug use, concurrent infection, and malnutrition. The most significant risk factor in our cases was poorly controlled type 2 diabetes mellitus. Poorly controlled diabetes is known to cause impaired clearance of pathogens, predisposing patients to abscess formation. Both patients also delayed presenting to the hospital due to concerns surrounding the coronavirus disease of 2019 (COVID-19) pandemic. We describe the use of a deltoid-pectoral approach to access the subscapular abscess allowing surgical drainage. The supraspinatus abscess was drained by direct incision. We advocate utilising common and familiar approaches with or without arthroscopy where possible. These cases highlight the importance of early imaging in patients presenting with the physiological signs of infection and idiopathic shoulder pain.

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“…Another possible devastating complication of the corticosteroid injection is subsequent infection. There have been several case reports regarding the infection risk following the corticosteroid injection [12, 27, 29]. Armstrong and Dias [1] reported a correlation between intraoperative intra‐articular corticosteroid injection and onset of septic arthritis following arthroscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re-tear rate after arthroscopic rotator cuff repair

Lee

Kim

Choi

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to compare clinical outcomes and structural integrity following arthroscopic rotator cuff repair, either with intra‐articular injection of corticosteroids in the early postoperative period using ultrasound guidance or without it. MethodsThis study included 318 patients who underwent arthroscopic repair for either a partial‐thickness or small‐to‐medium‐sized full‐thickness rotator cuff tear from 2012 to 2015. Patients were divided into two groups based on the administration of an intra‐articular corticosteroids injection at 3 months after the surgery: group A (with corticosteroid injection, n = 56) and group B (without corticosteroid injection, n = 262). Functional outcomes were evaluated using the visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion (ROM). Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity. ResultsAt the 2‐year follow‐up, both groups showed no significant differences in VAS pain score (group A/B, 1.1 ± 0.9/1.1 ± 1.1), functional scores including SSV (88.5 ± 10.8/88.3 ± 10.0), ASES (90.8 ± 6.6/90.4 ± 6.9), and UCLA scores (30.2 ± 5.6/30.7 ± 5.2), and active ROM including forward flexion (151° ± 8°/153° ± 7°), external rotation (54° ± 5°/55° ± 7°), and internal rotation (10 ± 1/10 ± 2). Follow‐up MRA imaging collected 6 months after surgery showed no significant difference in the re‐tear rate (n.s.) between group A and B (n = 10/56, 17.9% and 45/262, 17.2%, respectively). ConclusionsIntra‐articular corticosteroids injection in the early postoperative period after arthroscopic rotator cuff repair provided satisfactory pain relief and ROM improvement without increasing the re‐tear rate or deteriorating clinical outcomes at the 2‐year follow‐up. Level of evidenceIII.

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Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection

Cited by 4 publications

References 48 publications

Schaalia (Formerly Actinomyces) turicensis Infection Following Open Rotator Cuff Repair

Schaalia (Formerly Actinomyces) turicensis Infection Following Open Rotator Cuff Repair

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

Intra-articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re-tear rate after arthroscopic rotator cuff repair

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