Postoperative deep shoulder infections following rotator cuff repair

Abstract

Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.

Keywords: Deep shoulder infection; Postoperative complication; Rotator cuff repair; Shoulder surgery.

Figure 1

Drainage from an infected arthroscopy portal immediately before the arthroscopic debridement and lavage. After anesthesia the patient is positioned and the shoulder is draped. An incision is made through the infected portal and cultures are taken from the draining pus. Additional deep tissue cultures are sent during the arthroscopic debridement (Courtesy of University of Manitoba, Section of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada).

Figure 2

Arthroscopic view of the glenohumeral joint space from a patient with deep shoulder infection after rotator cuff repair. It is possible to visualize the pus and severe tissue inflammation before the irrigation (Courtesy of University of Manitoba, Section of Orthopaedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada).