Shoulder and arm-12 year

[Samuel Katumba]

Hi Steve
Sorry for sub optimal images

12 year old boy presented with swollen painful shoulder, fever + could not abduct arm.
Enticed with obvious shoulder swelling, much of my effort was focused on shoulder-all I could see was fluid in gleno-humeral joint, in SASD bursa and between brachialis and humerus…I could not explain the findings.
Curiously, I continued my adventure to wherever I could find an explanation, and I landed on echogenic and swollen muscle in postero-medial aspect of upper (think it was long head triceps)-with an echogenic turbid collection devoid of color signals? Abscess.
What was I dealing with here? How do these findings fit together? What could be the differentials?
Thank you
Samuel

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[Samuel Katumba]

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[Stephen Bird]

Hi Samuel,

Nice images,

Personally I think the shoulder joint and bursa are normal.

I agree there is some fluid between the humerus and the distal biceps tendon but this fluid displaces the tendon anteriorly and I don’t think it is in the LHBT sheath / GH joint.

The arm musculature is where the problem is here,

It looks like a nasty infection involving the muscles of the upper arm.

As this collection reaches the cortex of the bone an osteomyelitis needs to be a consideration,

Whatever the cause, I think sepsis and abscess formation is the answer and I don’t think the shoulder GH joint is the source but rather humeral shaft or directly in the musculature.

I imagine they will try and aspirate the abscess and culture it to find the infection source and plain radiographs of the shoulder / humerus will also be of benefit.

Very interesting case mate.

Let us know what follow up you can discover.

Steve

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