Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Oct:111:108847.
doi: 10.1016/j.ijscr.2023.108847. Epub 2023 Sep 17.

SARS-Cov-2 related shoulder pain and stiffness associated to humeral osteolysis after arthroscopic rotator cuff repair: A case report

Erica Lante  1 , Grishma Mahé  2 , Richard Jany  3
Affiliations
Case Reports

SARS-Cov-2 related shoulder pain and stiffness associated to humeral osteolysis after arthroscopic rotator cuff repair: A case report

Erica Lante et al. Int J Surg Case Rep. 2023 Oct.

Abstract

Introduction and importance: Complications using bioresorbable anchors in arthroscopic rotator cuff surgery include osteolysis, aseptic synovitis, and foreign body reaction. However, the precise triggering factors are unknown.

Case presentation: A healthy, 63-year-old male patient underwent rotator cuff repair using 7PLGA/b-TCP anchors. Nine months after surgery he returned to the senior author because of right shoulder pain and stiffness, pain in the right hand, foot and leg, and presence of erythematous patches at the aforementioned joints following SARS-Cov-2 infection, as well as increasing in blood inflammatory markers. Magnetic Resonance Arthrography (Arthro-MRI) showed no rotator cuff tendons re-tear but intra-articular synovitis, subacromial bursitis and humeral osteitis. A diagnostic arthroscopy, intra-articular fluid collection, biopsy and joint lavage was performed to rule out a septic arthritis. Co-amoxicillin 2.2 g intravenous treatment was administered following samples. Histological analysis of synovial tissue showed fibrin-exudative synovitis, while humeral bone biopsy showed an anchor resorption reaction. All microbiological analysis showed sterile samples. Three months post-lavage follow-up physical examination showed painless, recovered mobility, while Arthro-MRI showed a significant post-refixation remodeling of the rotator cuff tendons and reduction in humeral head osteitis and synovitis.

Clinical discussion: The abrupt onset of symptomatology and the close chronological link with SARS-Cov-2 infection suggests a causal relationship between clinical and radiological manifestations and the infection itself, with clinical and radiological manifestation being a viral host response reaction to SARS-Cov-2 infection.

Conclusion: Shoulder pain, stiffness and humeral osteitis could be manifestations of a viral host response to SARS-Cov-2 infection.

Keywords: Arthroscopic rotator cuff repair; Bioresorbable anchors; Humeral Osteolysis; PLGA/B-TCP; SARS-Cov-2; Viral host response.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest N/A

Figures

Fig. 1
Fig. 1
Arthro-MRI (axial (a), coronal (b), parasagittal (c) plane) T1-weighted, pre-operative.
Fig. 2
Fig. 2
X-ray (AP) follow-up at 6 weeks post arthroscopic rotator cuff repair.
Fig. 3
Fig. 3
Arthro-MRI (axial (a), coronal (b), parasagittal (c) plane) T1-weighted, 3 months post arthroscopic rotator cuff repair.
Fig. 4
Fig. 4
X-ray (AP) follow-up at 6 weeks post arthroscopic debridement and lavage.
Fig. 5
Fig. 5
Arthro-MRI (axial (a), coronal (b), parasagittal (c) plane) T1-weighted, 3 months post arthroscopic debridement and lavage.
See this image and copyright information in PMC

References

    1. Lee J.H., Lee Y.B. Clinical and radiologic outcomes of combined use of biocomposite and peek suture anchors during arthroscopic rotator cuff repair: a prospective observational study. J. Clin. Med. 2020;9:1–10. doi: 10.3390/jcm9082545. - DOI - PMC - PubMed
    1. Ma R., Chow R., Choi L., Diduch D. Arthroscopic rotator cuff repair: suture anchor properties, modes of failure and technical considerations. Expert Rev. Med. Devices. 2011;8:377–387. doi: 10.1586/erd.11.4. - DOI - PubMed
    1. Barber F.A., Spenciner D.B., Bhattacharyya S., Miller L.E. Biocomposite implants composed of poly(Lactide-co-Glycolide)/β-Tricalcium phosphate: systematic review of imaging, complication, and performance outcomes. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2017;33:683–689. doi: 10.1016/j.arthro.2016.09.032. - DOI - PubMed
    1. Micic I., Kholinne E., Kwak J.M., Koh K.H., Jeon I.H. Osteolysis is observed around both bioabsorbable and nonabsorbable anchors on serial magnetic resonance images of patients undergoing arthroscopic rotator cuff repair. Acta Orthop. Traumatol. Turc. 2019;53:414–419. doi: 10.1016/j.aott.2019.08.015. - DOI - PMC - PubMed
    1. Glueck D., Wilson T.C., Johnson D.L. Extensive osteolysis after rotator cuff repair with a bioabsorbable suture anchor: a case report. Am. J. Sports Med. 2005;33:742–744. doi: 10.1177/0363546504269254. - DOI - PubMed

Publication types