An affection started after the
work in the garden where the patient did an excessive physical effort. The
second day after work he has pains in the shoulder which annoy him. The pains
are at rest, but they are getting worse during movements, but at night
he can sleep without any problems. Otherwise he feels healthy. He goes to
the orthopaedic outpatient department where they administer him 10 mg of Kenalog
into the shoulder joint. Next day after the application he has high temperature
(39C), shivering and chill, and pains are intensified. His state is acutely
getting worse, and he is taken to the internal department where he is seen by an
orthopaedist again. Regarding to a normal
finding in X-ray!!! The orthopaedist eliminates septic arthritis, and
administers other 15 mg of Kenalog into the shoulder joint. But pains are still
getting worse, and it is not possible to suppress them by Morphine.
Then by chance the patient comes to an ultrasound examination with a diagnosis
of a frozen shoulder. Objective finding:
The patient is lying, febrile,
“near to the death“, he has to be brought to the examination on the bed.
Extensions of Movements of the Shoulder
The patient has very so strong
pains that he cannot actively abduct the shoulder over 20 degrees. At the
examination we are able to abduct patient’s arm about to 40 degrees. We have
to do it with a great care because of strong pains.
picture and scheme of septic arthritis in the glenohumeral
articulation – transversal section
videosequence of septic arthritis in the glenohumeral articulation – transversal section
picture and scheme of septic arthritis in the glenohumeral
articulation – axillary section in a comparison with the healthy side