Septic shoulders in children

A review was carried out on nine children who were diagnosed and treated for septic arthritis of the glenohumeral joint at the University of California, San Diego affiliated hospitals. Eight of the nine patients were under 18 months of age at the time of diagnosis. Three patients had a history of antecedent trauma, and four had a previous or concurrent source of infection. The longest delay between the onset of symptoms and diagnosis was 30 days with the majority being diagnosed within 4 days of onset. Laboratory findings revealed a mean white blood cell count of 17,400 and a mean temperature of 39.3°C. The sedimentation rate was always greater than 30 mm and averaged nearly 60 mm in these nine patients. Joint cultures were positive for a variety of organisms. Early radiographic findings often demonstrated widening of the joint space. Associated osteomyelitis of the proximal humerus was present in five of nine patients. Once the diagnosis has been established by aspiration, we recommend arthrotomy. Important aspects of the surgery include drainage of the joint and bicipital recess, and drilling of the proximal humeral metaphysis to rule out osteomyelitis or to more adequately decompress the bone.