Acute Osteomyelitis in the Proximal Humerus Caused by Pyogenic Glenohumeral Arthritis in an Elderly Patient - A Case Report

Hyun, Yoon-Suk;Kwon, Jae-Woo;Hong, Sung-Yup;Han, Kyeol

  • Received : 2014.08.21
  • Accepted : 2014.11.05
  • Published : 2014.12.30


Reports of osteomyelitis in the proximal humerus with pyogenic glenohumeral arthritis of adjacent joints mostly involve pediatric patients. Nowadays, osteomyelitis that is secondary to adjacent pyogenic glenohumeral arthritis is extremely rare, even more so in adults than in pediatrics. We report a rare case of the pyogenic glenohumeral arthritis followed by osteomyelitis of the proximal humerus in an elderly patient. Initially, we diagnosed a case of pyogenic glenohumeral arthritis only, which, despite arthroscopic synovectomy, did not resolve and severe pain continued. Subsequent radiological imaging, performed after our suspicion of a secondary involvement, allowed us to diagnose osteomyelitis combined with the pyogenic glenohumeral arthritis, which we had overlooked because of the extreme rarity of the condition in adults since the antibiotic era began.


Septic arthritis;Shoulder;Osteomyelitis


  1. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005;41(1-2):59-62.
  2. Perlman MH, Patzakis MJ, Kumar PJ, Holtom P. The incidence of joint involvement with adjacent osteomyelitis in pediatric patients. J Pediatr Orthop. 2000;20(1):40-3.
  3. Shin SJ, Jeong BJ, Kook SH, Shin SJ. Acute osteomyelitis of the humeral head after arthroscopic rotator cuff repair. Clin Shoulder Elbow. 2013;16(2):141-7.
  4. Murray RJ, Pearson JC, Coombs GW, et al. Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection. Infect Control Hosp Epidemiol. 2008;29(9):859-65.
  5. Nade S. Acute septic arthritis in infancy and childhood. J Bone Joint Surg Br. 1983;65(3):234-41.
  6. Alderson M, Speers D, Emslie K, Nade S. Acute haematogenous osteomyelitis and septic arthritis: a single disease. An hypothesis based upon the presence of transphyseal blood vessels. J Bone Joint Surg Br. 1986;68(2):268-74.
  7. Trueta J. The three types of acute haematogenous osteomyelitis: a clinical and vascular study. J Bone Joint Surg Br. 1959;41(4):671-80.
  8. Abdel MP, Perry KI, Morrey ME, Steinmann SP, Sperling JW, Cass JR. Arthroscopic management of native shoulder septic arthritis. J Shoulder Elbow Surg. 2013;22(3):418-21.
  9. Rhee YG, Cho NS, Kim BH, Ha JH. Injection-induced pyogenic arthritis of the shoulder joint. J Shoulder Elbow Surg. 2008;17(1):63-7.
  10. Bierry G, Huang AJ, Chang CY, Torriani M, Bredella MA. MRI findings of treated bacterial septic arthritis. Skeletal Radiol. 2012;41(12):1509-16.