A patient was sent to the internal department from the orthopaedic outpatient department with a requirement of analgesicly-relaxing infusing therapy of 1 year lasting pains of the right shoulder. In the orthopaedic outpatient department was made 5 times a peritendinous injection of the shoulder with Kenalog, but without any success. Pains arose slowly, but during the last time they are unbearable. Now they are also present at rest. The patient cannot sleep due to the pains. Except pains of the shoulder the patient feels himself without any other problems. Afebrile. He does not loose weight. Till now the patient was under the diagnosis of periarthritis humeroscapularis.
FW 10/20!!!
Blood picture and basic biochemical screening are in a norm.
picture
and scheme of staphylococcal bursitis
videoclip of staphylococcal bursitis
3 ml of a highly inflammatory yellow-brown liquid. After aspiration there is a big improvement of the problems till the second day. Later the problems are getting worse again.
synovialogram |
WBC 78 000 segments 0, 89 mono 0,11 |
microscopically |
without any presence of crystals |
cultivation |
Staphylococcus aureus |
It is probably that infectious bursitis arose after intra-articular steroid therapy. This therapy could also participate in negative inflammatory reaction of the organism without laboratory manifestation of the inflammation and fever, and therefore we did not seriously think about infectious etiology. The ultrasound diagnostics with an aspiration enabled to diagnose immediately that was forgotten for a half of the year.