Shoulder joint abscess is a condition in which, the shoulder joint may be affected with certain conditions that cause accumulation of pus in and around the joint. Abscess or building up of pus can occur around the shoulder joint or the soft tissues around it, which include ligaments, muscles and other tissues. Abscess of the shoulder joint can also be present over the skin surface, which can be easily visible.
While there are various factors affecting the occurrence of abscess, the commonest cause of shoulder joint abscess may be infections. Shoulder joint abscess can affect anyone, at any age and some risk factors may be more influential in increasing the risk of shoulder infections or abscess.
The causes and symptoms of shoulder joint abscess must be understood clearly to raise the suspicion of a possible abscess around the shoulder. Just as the diagnosis of shoulder joint is very important, appropriate treatment and wound care too, plays an important role in managing the condition. If there are any other factors contributing to the occurrence or recurrence of shoulder joint abscess, they need to be identified and corrected as well.
Causes of Shoulder Joint Abscess
Some of the common causes of shoulder joint abscess include
Injury to the skin surface or to the deeper tissues around the shoulder joint is one of the common causes of shoulder abscess. A minor cut or a deeper wound, if not treated properly in time, can be a potential site of infection, which can cause pus collection in the area. Shoulder joint abscess can be caused by injuries, fractures, foreign body, bites, burns or scalds, which cause damage to the skin surface, subcutaneous tissues or to the deeper tissues. Injury to the shoulder joint or the supporting muscles include inflamed tendons, bursa, muscle or ligament tear.
Improper wound care after injuries can cause infections, which can even affect the muscles and other structures supporting the shoulder joint. The commonest cause of infected wounds is bacterial infection, however, other microorganisms may too sometimes cause abscess in shoulder joint after injuries.
Skin infections are another common cause of shoulder joint abscess. Skin eruptions, skin diseases and other skin problems can affect the skin surface causing boils, carbuncles, cellulitis and skin abscess. These skin infections or boils are commonly seen over the shoulder joint area, on the back or front of the shoulders or in the armpits. When skin lesions get infected, due to scratching, rubbing or additional injuries, pus formation results and can cause an abscess over the shoulder joint. Sometimes, such skin infections increase the risk of spreading the infection to inner tissues and can cause shoulder joint abscess.
Shoulder Joint Abscess Caused Due to Shoulder Infections and Septic Arthritis
Shoulder joint is a widely used joint and also a potential site for infections. Shoulder infections and septic arthritis can be a cause of shoulder joint abscess. Septic arthritis is an infection in the joint, which causes inflammation in one or more joint. It is a form of arthritis or inflamed joint, caused due to infection, mostly bacterial. It can occur spontaneously, show symptoms of infection and may rapidly progress. Sometimes, septic arthritis affecting the shoulder or a neighboring joint can also be a cause of shoulder joint abscess.
Shoulder joint infections and septic arthritis can be seen more in people who have undergone recent surgery or those having prosthetic devices in the joint. Previous joint injuries, inflammatory joint conditions and problems with shoulder joint too can increase the chances of septic arthritis and cause shoulder joint abscess. People having immunodeficiency, autoimmune disorders, other forms of arthritis and diabetes have greater risk of septic arthritis causing shoulder joint abscess.
Other Causes of Shoulder Joint Abscess
Shoulder joint abscess can sometimes also be a result of skin and joint infections at other location, which can spread to the shoulder joint. Abscesses at other locations, spinal cord abscess, which can sometimes affect the shoulder joint or inflammation, infections or diseases affecting the muscles, ligaments or tissues around the shoulder joint.
Risk Factors of Shoulder Joint Abscess
Certain risk factors have been identified, which can raise the chances of shoulder joint abscess in some people.
- People with a weak immune system, those taking immunosuppressant drugs, people with a history of autoimmune disorders, connective tissue disorders, internal abscesses or infections like HIV/AIDS, etc. People having sensitive skin, those with past or present history of skin diseases, skin or subcutaneous abscesses, too can develop shoulder joint abscess.
- People with rheumatoid arthritis, shoulder inflammation or conditions affecting the shoulder joint, previous septic arthritis, shoulder infections or shoulder joint abscess may be at an increased risk of shoulder joint abscess. Those who have undergone surgeries of the shoulder joint, drainage of abscess near the shoulder area or those with a prosthetic device near the shoulder joint are at greater risk of developing shoulder joint abscess.
- People having diabetes, poorly controlled blood sugar levels or those with complications of diabetes, skin ulcers, etc. may be considered at increased risk of shoulder abscess.
Symptoms of Shoulder Joint Abscess
The symptoms of shoulder joint abscess depend on the type and location of the abscess developed. It is important to understand the symptoms of shoulder joint abscess and the ways in which it can affect a person.
Symptoms of Skin Abscess Over Shoulder Joint
Certain abscesses developed over the skin may present with skin lesion, which may be noticeable with red, itchy skin over the shoulder. The symptoms of shoulder joint abscess, which present on the skin surface, include elevated areas, red and itchy, which can be painful or oversensitive patches of skin. The pus filled lesions are abscess over the skin around the shoulder joint. The skin under which pus gets collected is often soft to touch and can be very painful.
If the lesion or the shoulder abscess bursts open, it can drain the pus, which requires to be managed well. The skin lesion of shoulder abscess can also get hardened or thickened with time but remains painful. The area around the shoulder joint abscess can be painful and sensitive to touch. Depending on the exact location of the skin abscess, there may also be difficulty in moving the shoulders or raising the arms. Shoulder abscess can also interfere with daily routine activities and make it difficult to perform certain tasks.
Symptoms of Deeper Abscess in Shoulder Joint Abscess
Certain abscess may develop in the deeper tissues of the shoulder joint. They are often not visible but present with certain symptoms. The common symptoms of shoulder joint abscess in such cases include:
- Shoulder Pain - Pain in the shoulder joint is one of the major symptoms of shoulder joint abscess. Pain may originate in the shoulder and can travel down the arms and hands as well. Pain can sometimes also extend to the back or the chest region, depending on the location of the shoulder abscess. Shoulder joint and the surrounding muscles are severely painful when trying to move and may also be sensitive to touch. Shoulder pain in shoulder joint abscess may also be associated with stiffness of the shoulder joint. Stiffness and pain in shoulder may develop suddenly and can be felt more during the night or long periods of inactivity.
- Inflammation – Inflammation is noted in shoulder joint abscess, which could be a sign of inflammation in the shoulder joint or in the surrounding muscles and tissues. Swelling may be noted around the shoulder joint, redness and warmth may also be felt over the shoulder joint.
- Difficulty With Shoulder Movements – Shoulder joint abscess causes difficulty in shoulder movements. The person may find it difficult or painful to move the shoulders, raise hands overhead, lift objects or perform regular functions. Range of motion and rotation movements of the shoulder are usually affected in shoulder joint abscess.
Sometimes, shoulder joint abscess can be located at a place, where it can cause impingement or exert pressure on certain important structures. This can cause inflammation to the surrounding tissues or even affect the vascular structures or nerves in the region. Impingement due to shoulder joint abscess can sometimes cause bursitis, tendinitis, pain in the arms and hands. If nerves get compressed, pain may radiate to the hands, cause burning and tingling sensation or numbness in hands and fingers in some cases.
Other symptoms of shoulder joint abscess include signs of infections, fever and chills, which may be of sudden onset.
Diagnosis of Shoulder Joint Abscess
Diagnosis of shoulder joint abscess is a comprehensive approach, which includes personal and medical history of the person, clinical examination of the skin lesion or the wound and investigations.
Proper history can help to reveal underlying medical conditions, skin infections or skin abscesses over the shoulder joint. It can also help to evaluate shoulder or other joint problems and the recurrence of shoulder infections or shoulder joint abscess. History of diabetes or other disorders that increase the risk of shoulder joint abscess can be known.
Clinical examination of cuts, wounds, bites, skin lesions or burns on the skin surface of the shoulder joint give an idea of the possible causes of shoulder joint abscess. Any injury, fracture, penetrating injury, presence of foreign body, etc. is evaluated to plan appropriate treatment for shoulder joint abscess. Deep seated abscess in shoulder joint can be suspected by clinical examination of the shoulder joint, its movements and the surrounding structures.
Investigations for Shoulder Joint Abscess
Certain investigations are often needed to confirm the diagnosis of shoulder joint abscess. These include
Blood Tests - Blood tests may be ordered to detect the presence of infection in the body or those affecting the shoulder joint. These help to detect septic arthritis, shoulder infections or other general infections that can cause shoulder joint abscess in some people. Specific type of micro-organism can be detected by specialized tests, which aid in diagnosis and treatment of shoulder joint abscess.
Blood tests may also be done to rule out other infections, infective arthritis, other forms of arthritis, underlying medical conditions, connective tissue or autoimmune disorders that can affect the skin and cause shoulder joint abscess. It also helps to check blood sugar levels and assess diabetes control, which can aid in proper management of shoulder joint abscess.
- Scans – If deep seated abscess is suspected, bone scans and imaging studies may be required. X-rays and CT scans of the shoulder joint can reveal bony abnormalities, bone injuries, fracture, foreign bodies or diseases affecting the bone. MRI is helpful in detecting soft tissue injuries, ligament or muscle tears or any abnormality of tissues causing shoulder joint abscess. Scans of other joints or spine may be considered if other joints are involved or if found necessary to aid the diagnosis and treatment of shoulder joint abscess.
- Abscess Drainage - Drainage of pus may be considered as a part of diagnostic modality, to confirm diagnosis and support the treatment for shoulder abscess. This test can help to detect the presence of infection, the causative organism and any other abnormality causing the shoulder joint abscess. The drained fluid or pus is sent for laboratory testing and culture analysis.
Other investigations may be considered, as appropriate, depending on the cause and symptoms of shoulder joint abscess. Some cases of inflamed shoulder joint may require joint aspiration, where the synovial fluid in the shoulder joint is aspirated and sent for analysis. A prosthetic joint must also be properly investigated with scans or synovial fluid aspiration to check for site of infection. It can aid in diagnosing joint related conditions and septic arthritis of the shoulder joint.
Treatment of Shoulder Joint Abscess
Treatment of shoulder joint abscess, largely depends on the cause, location and extent of the shoulder abscess. The main aim of treatment of shoulder abscess is to treat the infection or the condition causing shoulder joint abscess, restore normal functioning and manage underlying conditions related to shoulder joint abscess.
Certain skin abscesses over the shoulder joint may drain or heal on their own, but may often repeat and treatment is required to completely cure the infection.
Some common treatment options for shoulder joint abscess include:
Antibiotics – Antibiotics are often required to treat the infection. Injuries, burns and bites often require proper wound care. Such injuries and infections affecting the bone or soft tissues, causing shoulder joint abscess, may be treated with antibiotics and other necessary treatment.
Some shoulder infections or cases of shoulder joint abscess may be resistant to certain strains of bacteria, when other antibiotics may have to be given. Antibiotic creams may be prescribed for shoulder abscesses on the skin surface. Once the causative microorganism is confirmed by the blood test results additional specific treatment or antibiotics, may be considered.
Other medications may be given depending on the causes and underlying conditions. Diabetes needs appropriate treatment to keep blood sugar levels controlled, which can promote healing of infections and help in recovery of shoulder joint abscess. Autoimmune disorders or connective tissue diseases must be treated appropriately to control skin infection and shoulder abscess. Medications may be given to control pain and itching in skin abscess or shoulder joint. High fever may be managed with fever medicines.
It is important to know that in shoulder joint abscess, repeated or worsening joint infections, excessive reddening of skin, worsening of skin lesions, eruption of skin abscesses elsewhere in the body, persistent high fever and development of newer symptoms may require immediate medical care. Septic arthritis, with severe shoulder pain, high fever and sudden onset need immediate medical treatment.
Drainage of Pus – Some cases of shoulder joint abscess may require drainage of pus as the best treatment option. It usually helps to cure the infection and also prevent the recurrence of shoulder joint abscess. The best treatment option for shoulder joint abscess is decided by the treating physician and drainage of pus is performed by the experts. After pus drainage, the area is cleaned and medications may be applied to the area to prevent infections and promote healing.
Splinting – The shoulder joint may have to be splinted as a part of the treatment of shoulder joint abscess or after drainage of pus, if appropriate. It helps in immobilization and can aid in recovery of the shoulder joint. After healing and control of infection, the joint can be mobilized to restore its functions.
Surgical Treatment for Shoulder Joint Abscess
Some cases of shoulder joint abscess, particularly those resulting from shoulder infections or septic arthritis, may need surgical treatment. The main aim of such surgical procedures are to remove the source of infection, foreign body and treat the shoulder joint. It is often done using an arthroscope, with the help of which, the infective source can be removed and the area can be irrigated with anti-biotics to treat the infection.
Untreated or complicated cases of shoulder joint abscess and shoulder infections may require shoulder arthroplasty to provide relief from chronic pain, stiffness and restricted shoulder movements.
Physical Therapy for Shoulder Joint Abscess
Minor abscesses of shoulder joint may show complete recovery with prompt treatment. However, shoulder abscesses in which there was shoulder pain, affected shoulder functions, or problems with shoulder joint must be followed with physical therapy. Post-surgical cases of shoulder infections, too need physical therapy for complete recovery.
Following necessary treatment of shoulder joint abscess, it is important to reduce pain, swelling and restore normal function of the shoulder joint. Physical therapy for shoulder joint abscess is aimed at this and makes use of modalities to provide relief from pain, inflammation and aids in recovery. This is more important for cases of arthritis, septic arthritis, shoulder stiffness and shoulder pain. Therapeutic exercises can help to maintain flexibility of the joint, strengthen the muscles and improvement range of motion.
Complications of Shoulder Joint Abscess
Prompt treatment of shoulder joint abscess usually helps to treat the infection and condition with complete recovery. However, in some cases, shoulder joint abscess can spread to nearby areas or to deeper tissues, resulting in certain complications. If other contributing factors are not managed well, the shoulder abscess or infection can cause damage to internal structures, result in non-healing wounds and gangrene or death of tissue in some cases.
Shoulder joint abscess can respond well to immediate treatment, however, if treatment is delayed, it can result in long term shoulder pain, stiffness of shoulder joint and joint destruction in some case.
Prevention of Shoulder Joint Abscess
Skin abscess can be prevented by maintaining good hygiene and hand washing habits to prevent skin infections. It is also important to note that any skin infection, boils or abscesses should be promptly treated in an appropriate way. Injury, wounds, cuts, burns or bites around the shoulder must be properly cleaned, treated well and proper wound care is important to prevent infections and shoulder abscess. People with joint problems, previous shoulder infections or septic arthritis can maintain flexibility, strength and good blood circulation with regular exercise. It is also important to be vigilant about the early symptoms of shoulder joint abscess and seek timely medical attention.