Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review
Abstract Background Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is frequently a missed or delayed diagnosis. Reliance on aspiration and serum markers has been called into questi...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-022-05385-8 |
| _version_ | 1811341068339249152 |
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| author | Luis M. Salazar Jose M. Gutierrez-Naranjo Clarissa Meza Andrew Gabig Aaron J. Bois Christina I. Brady Anil K. Dutta |
| author_facet | Luis M. Salazar Jose M. Gutierrez-Naranjo Clarissa Meza Andrew Gabig Aaron J. Bois Christina I. Brady Anil K. Dutta |
| author_sort | Luis M. Salazar |
| collection | DOAJ |
| description | Abstract Background Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is frequently a missed or delayed diagnosis. Reliance on aspiration and serum markers has been called into question recently. The purpose of this study was to conduct a systematic review investigating the value of joint aspiration and serum markers in the diagnosis of native shoulder joint sepsis. Methods PubMed/MEDLINE, Scopus, and the Cochrane Library were used in the systematic literature search from January 1, 1960, through January 23, 2021. The primary outcome was to report on the synovial white cell count of patients with native shoulder sepsis. Descriptive statistics using percentages, means, and intraclass correlation coefficient (ICC) values were used to summarize the results. Results Thirty-one studies, including 25 case series, one case-control, and five cohort studies with a total of 7434 native shoulder joints, were included. There was no standardized approach to diagnosing septic arthritis of the shoulder. Only 10 studies (32%) reported on synovial white cell count with the majority yielding aspiration counts greater than 50,000 cells/mm3, although one study was as low as 30,000 cells/mm3. Conclusions The diagnosis of native shoulder joint sepsis lacks uniformity. Methods used to evaluate shoulder sepsis are heterogeneous and may lead to delays or misdiagnosis with devastating sequelae. Synovial white cell count is underutilized and may also present with a lower value than expected, which is likely related to the time interval between symptom onset and diagnosis. |
| first_indexed | 2024-04-13T18:51:16Z |
| format | Article |
| id | doaj.art-bba57c65d3de46a3b9a16dd648a3f2f3 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-13T18:51:16Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-bba57c65d3de46a3b9a16dd648a3f2f32022-12-22T02:34:25ZengBMCBMC Musculoskeletal Disorders1471-24742022-05-0123111210.1186/s12891-022-05385-8Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic reviewLuis M. Salazar0Jose M. Gutierrez-Naranjo1Clarissa Meza2Andrew Gabig3Aaron J. Bois4Christina I. Brady5Anil K. Dutta6UT Health San Antonio, Long School of MedicineUT Health San Antonio, Department of OrthopaedicsUT Health San Antonio, Long School of MedicineUT Health San Antonio, Long School of MedicineUniversity of Calgary, Sport Medicine CentreUT Health San Antonio, Department of OrthopaedicsUT Health San Antonio, Department of OrthopaedicsAbstract Background Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is frequently a missed or delayed diagnosis. Reliance on aspiration and serum markers has been called into question recently. The purpose of this study was to conduct a systematic review investigating the value of joint aspiration and serum markers in the diagnosis of native shoulder joint sepsis. Methods PubMed/MEDLINE, Scopus, and the Cochrane Library were used in the systematic literature search from January 1, 1960, through January 23, 2021. The primary outcome was to report on the synovial white cell count of patients with native shoulder sepsis. Descriptive statistics using percentages, means, and intraclass correlation coefficient (ICC) values were used to summarize the results. Results Thirty-one studies, including 25 case series, one case-control, and five cohort studies with a total of 7434 native shoulder joints, were included. There was no standardized approach to diagnosing septic arthritis of the shoulder. Only 10 studies (32%) reported on synovial white cell count with the majority yielding aspiration counts greater than 50,000 cells/mm3, although one study was as low as 30,000 cells/mm3. Conclusions The diagnosis of native shoulder joint sepsis lacks uniformity. Methods used to evaluate shoulder sepsis are heterogeneous and may lead to delays or misdiagnosis with devastating sequelae. Synovial white cell count is underutilized and may also present with a lower value than expected, which is likely related to the time interval between symptom onset and diagnosis.https://doi.org/10.1186/s12891-022-05385-8Shoulder sepsisSeptic arthritisGlenohumeral joint sepsisDiagnosisShoulder |
| spellingShingle | Luis M. Salazar Jose M. Gutierrez-Naranjo Clarissa Meza Andrew Gabig Aaron J. Bois Christina I. Brady Anil K. Dutta Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review BMC Musculoskeletal Disorders Shoulder sepsis Septic arthritis Glenohumeral joint sepsis Diagnosis Shoulder |
| title | Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review |
| title_full | Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review |
| title_fullStr | Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review |
| title_full_unstemmed | Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review |
| title_short | Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review |
| title_sort | joint aspiration and serum markers do they matter in the diagnosis of native shoulder sepsis a systematic review |
| topic | Shoulder sepsis Septic arthritis Glenohumeral joint sepsis Diagnosis Shoulder |
| url | https://doi.org/10.1186/s12891-022-05385-8 |
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