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SHOULDER

Anatomy

The shoulder joint is the second largest and most mobile joint in the human body and can be easily understood if divided into three layers. view 

Shoulder Contusion

Trauma is the term used to describe injury. Trauma is classified by its severity depending on the amount of force used to cause the injury. view 

Shoulder Fractures

Shoulder Fractures or breaks in the shoulder can occur in the humeral bone, collar bone or the in shoulder blade.  view

Shoulder Dislocations

A shoulder dislocation is classified according to the direction of the dislocation (Anterior, posterior or multi-directional), the amount of force it took to dislocate the shoulder (Traumatic or Atraumatic), and whether it is accompanied by a fracture (fracture dislocation).  view 

Shoulder Arthiritis

Shoulder Arthritis is the loss of the cartilage cushion in the joint surfaces (blue section) that allows the smooth pain free gliding required during shoulder motion. view

Shoulder Nerve Compression Syndromes

Nerve compression syndromes are normally found in adults of all ages and it is rare to find nerve compression syndromes in patients younger than 20 years of age.  view 

Shoulder Tendon Disorders

Shoulder pain is the most common presenting shoulder complaint in an orthopedic practice.  view 

Shoulder Infection

The shoulder is one of the most well perfused areas of the human body and because of this ample blood supply to the shoulder which carries circulating white blood cells, offers excellent protection against infection, consequently making a shoulder infection a rare occurrence.  view 

Frozen Shoulder

A Frozen shoulderalso called adhesive capsulitis is a condition presenting withshoulder stiffness and severe shoulder pain when shoulder motion is initiated. view 

Shoulder Tumor

Tumors are divided into benign and malignant types.  view 

SHOULDER INFECTION

Pathology

The shoulder is one of the most well perfused areas of the human body. Due to the ample blood supply circulating white blood cells, the shoulder has excellent protection against infection.

In spite of this, there are certain conditions predisposing individuals to a shoulder infection. Predisposing Conditions include:

A penetrating shoulder injury that is not cleaned and repaired properly or timely. All penetrating injuries should seek medical advice for:

  1. Prophylactic antibiotics
  2. A tetanus booster if one has not been received within a 10 year period for clean injuries and within a five year period for dirty wounds
  3. Cleaning (debridement) of the wound

A postoperative wound to the shoulder

  1. During the post-operative period, the fresh wound is covered in sterile gauze until it seals
  2. Patients after surgery are advised to keep the dressing on and the wound dry for at least one week after surgery. If wound is uncovered, normal skin flora can invade the wound and cause an infection

Post joint replacement (arthroplasty)

  1. There is risk of infection if care is not provided to the post-operative wound
  2. Risk for an infection is increased because the surgery requires a large dissection which increases bleeding and tissue handling
  3. The joint replacement (implant) is also a foreign object in the human body where micro-organisms can hide and avoid the antibiotics used during surgery for infection prevention
  4. Individuals can also seed an implant with infections occurring elsewhere in the body that travel though the bloodstream, like a tooth abscess

Patient with a weak immune status. Examples of weak immune status can be due to:

  1. Chronic medical condition like diabetes or kidney failure
  2. Inflammatory condition like rheumatoid arthritis
  3. Use of immunosuppressive medication
  4. AIDS

Treatment

Factors Influencing Treatment Options

  • Initial cause of the infection
  • Whether the infection is superficial or deep and which tissues are involved
  • Length of time the infection has been present
  • Type of organism causing the infection
  • General medical condition and nutrition of the patient
  • Whether an implant is present or another type of foreign body

Superficial infections can be treated with oral antibiotics, warm soaks and resting the extremity.

Spreading infections with lymph node involvement bring on fevers and chills and hospital admission for intravenous antibiotics, fluids and systemic support is preferred.

If the infection is well loculated and fluctuant (soft), it is an abscess. This is a surgical condition requiring incision and drainage.

When a joint replacement has been done, it is prudent to admit the patient to the hospital for IV antibiotics in the first few days after surgery and have a low threshold for washing out the wound.

If the infection of the joint replacement occurs weeks or months after the surgery, then cultures are taken prior to giving antibiotics and the implant is usually removed. The implant can later be re-implanted after the organism has been identified and IV antibiotics have been given for six weeks. If the patient with a joint replacement has poor health or a poor immune status, then leaving the joint without an implant may be the best option.