Case 06

Question 1

Answer 1

called to review septic ac joint tap

HPI

atraumatic shoulder pain–ED-NSAIDS/Sling

Ortho- Cortisone SAS

Ortho- Ordered MRI after 4 weeks of treatment

PMH- gastric sleeve, electrician, RHD

Answer 2

Constitutional

BMI-36

RUE-

TTP, mass/warm

limited ROM/ no pain with

ADD/ER

Labs-13.2/5.3/40

127k cells/GS+/Culture–MSSA

Question 3

Answer 3

Pyomyositis with abcess in deltoid

Septic AC joint

DC osteomyelitis

GH joint preserved

Labs/ESR/CRP/WBC

Cell count/GS/Culture

Question 4

Answer 4

1. Ordered labs to evaluate for infection vs tumor vs exudate
2. Emergent vs Urgent intervention
3. obtained curbside surgical consults and reviewed the literature
4. organize team and develop surgical plan
5. Medical clearance/ID and pathology involvement

Question 5

Answer 5

Surgical Decision Making–

2. GH Intra-articular?
3. SAD- (scout team eval)
4. DCE

A. how much?

B. open vs arthoscopic

Iatrogenic CC joint instability

5. Other pathology found

Question 6

Answer 6

1. assess GH joint-dont contaminant- minimally invasive
2. SAS–LOA/debridement/ scout team–arthroscopic access the best route to full debride with low morbidity
3. Open DCE

remove bone with osteo

debride and Irrigate deltoid abscess.

4. Other biceps tenotomy

Question 7

Question 8

Answer 8

DCE technique recommends 8-10mm removal but this was in the setting of osteomyelitis

Care to avoid CC ligaments (conoid) and cause Iatrogenic CC instability

Need to remove infected bone

specimen for path

Question 9

Answer 9

admitted to hospital for 4 days of IV antbiotics

Given PICC line and discharged home

6 weeks in a sling with office follow-up

COVID restrictions

1 year follow-up

Question 10

Answer 10

1 year follow-up

asymptomatic

back to work

CC instability or bad x-ray?