A case of septic arthritis of shoulder presenting as rotator cuff tear

Septic arthritis of the shoulder is uncommon in adults. It is a surgical emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality. Accurate diagnosis can be particularly challenging in elderly patients with underlying shoulder pain. Both MRI and arthroscopy are useful modalities in early detection of atypical causes of shoulder pain. A 75 years old female came to our outpatient department with complaint of pain and stiffness of her right shoulder. On examination, her shoulder abduction movement was severely restricted. Further evaluation with MRI revealed massive joint effusion and supraspinatus tear and normal white blood cell with erythrocyte sedimentation rate 43 mm/h and C-reaction protein 41 mg/l. The septic arthritis was diagnosed only during arthroscopic debridement of right glenohumeral joint was conducted. Septic arthritis of shoulder may not present with typical clinical features. Hence, although comprehensive clinical and radiological and laboratory examination are imperative, an aspirate examination or arthroscopy can have a crucial role to make the definite diagnosis on clinically inconspicuous cases.