Septic Arthritis of the Pediatric Shoulder: From Infancy to Adolescence

Abstract

Background. Septic arthritis of the glenohumeral joint in the pediatric population (<18 yo) is not commonly described in the literature. There is a corresponding paucity of information regarding its presentation and treatment. Methods. An IRB approved review of patients treated with irrigation and debridement by the Orthopaedic Department was completed. This retrospective study includes four patients, presenting from 2005 to 2015, with septic arthritis of the shoulder. Results. The mean age (M age) at presentation was 5 years, with a range of 1 month to 15 years. Patients presented on average after 7 days with pain and a mean temperature of 39°C, erythrocyte sedimentation rate of 66 mm/hr, a C-reactive protein level of 11.17 g/dL, and a white blood cell count of 20.2 × 103/mcL. Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa were cultured from the wounds. All cases were treated operatively with irrigation and debridement and with antimicrobial therapy. Patients received antibiotics for an average of 6 weeks. Conclusion. Septic arthritis of the shoulder occurs in all pediatric ages. Successful treatment of septic arthritis of the shoulder was accomplished in four cases without division of the biceps sheath, with an average follow-up of 8 months.

Descriptive Epidemiology of Upper Extremity Septic Arthritis in Children—Review of a Retrospective Multicenter Database

“…Despite the contribution of consecutive patients from 18 children’s hospitals across the United States, most of which are the largest tertiary care children’s hospitals in their respective regions, we found that only 10% of cases of septic arthritis involved the shoulder, elbow, or wrist with a mean of fewer than 1 case per institution annually. Only a few small single-center case series have been published on pediatric septic arthritis of the shoulder and elbow 1–7,11,12,14. We are aware of only 5 case reports on pediatric septic arthritis of the wrist 8–11,13…”

“…Upper extremity septic arthritis (UESA) is uncommon in children, and there is a lack of published data on the characteristics, diagnostic findings, and management. While there are numerous studies investigating pediatric septic hip and knee arthritis, only a few small single-center case series and case reports have been conducted on pediatric UESA 1–14. As UESA is much less common than septic hip and knee arthritis, it is important for treating clinicians to maintain a high index of suspicion and include septic arthritis in the differential when patients present with joint symptoms, such as pain with motion, decreased range of motion, swelling, and erythema.…”

Predictive Algorithms in the Diagnosis and Management of Pediatric Hip and Periarticular Infection

“…Accordingly, the CRP level has remained a valuable tool in assessing the probability of SA. Obey et al, Singhal et al, Walker and Hennrikus, and Joshy et al all demonstrated its utility 9,12,14,15 . Importantly, a CRP level of >20 mg/L and non-weight-bearing alone were shown to predict SA with >70% probability in 2 of the studies 9,15 .…”

“…Since then, at least 10 additional studies have investigated the utility of the Kocher criteria (Table I) [6][7][8][9][10][11][12][13][14][15] . None have been able to replicate a predictive probability of >90% using only the original variables.…”

“…Finally, these studies are often inadequately powered for regression, and a range of statistical methods are applied 17 . Of all the external validation studies, 6 used multivariate regression, 5 used univariate analysis, and 1 used only descriptive statistics (Table II) 1,[5][6][7][8][9][10][11][12][13][14][15] . Statistical analysis has therefore been highly variable, and the techniques used for external validation are outlined in Table III.…”