Background: Deep infection of the shoulder
following rotator cuff repair is uncommon. There are few reports
in the literature regarding the management of such infections.
Methods: We retrospectively reviewed the charts
of thirteen patients and recorded the demographic data, clinical
and laboratory findings, risk factors, bacteriological findings,
and results of surgical management.
Results: The average age of the patients was
63.7 years. The interval between the rotator cuff repair and the referral
because of infection averaged 9.7 months. An average of 2.4 procedures
were performed prior to referral because of infection, and an average of
2.1 procedures were performed at our institution. All patients had
pain on presentation, and most had a restricted range of motion.
Most patients were afebrile and did not have an elevated white blood-cell
count but did have an elevated erythrocyte sedimentation rate. The
most common organisms were Staphylococcus epidermidis,Staphylococcus
aureus, and Propionibacterium species. At an average of 3.1
years, all patients were free of infection. Using the Simple Shoulder
Test, eight patients stated that the shoulder was comfortable with
the arm at rest by the side, they could sleep comfortably, and they were
able to perform activities below shoulder level. However, most patients
had poor overhead function.
Conclusions: Extensive soft-tissue loss or destruction
is associated with a worse prognosis. Extensive dè¡²idement, often
combined with a muscle transfer, and administration of the appropriate
antibiotics controlled the infection, although most patients were left
with a substantial deficit in overhead function of the shoulder.