Send to

Choose Destination
J Shoulder Elbow Surg. 2017 Sep;26(9):1553-1561. doi: 10.1016/j.jse.2017.01.008. Epub 2017 Mar 27.

Low-grade infections in nonarthroplasty shoulder surgery.

Author information

University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK.
The Arm Clinic at Wilmslow Hospital, Wilmslow, UK.
UKOMS Medical LTD, Sheffield, UK.
The Arm Clinic at Wilmslow Hospital, Wilmslow, UK; Wrightington Hospital, Wigan, UK; University of Salford, School of Health Sciences, Manchester, UK. Electronic address:



Recent studies have identified the diagnostic challenge of low-grade infections after shoulder arthroplasty surgery. Infections after nonarthroplasty procedures have not been reported. This study assessed patient-related risk factors, outcomes, and clinical presentation of low-grade infection after open and arthroscopic nonarthroplasty shoulder surgery.


The cases of 35 patients presenting with suspected low-grade infection were reviewed. Biopsy specimens taken at revision surgery were cultured in the sterile environment of a class II laminar flow cabinet and incubated for a minimum of 14 days at a specialist orthopedic microbiology laboratory. Patient-related factors (age, occupation, injection), index surgery, and infection characteristics (onset of symptoms, duration to diagnosis, treatment) were analyzed.


Positive cultures were identified in 21 cases (60.0%), of which 15 were male patients (71%). Of all patients with low-grade infection, 47.6% were male patients between 16 and 35 years of age. Propionibacterium acnes and coagulase-negative staphylococcus were the most common organisms isolated (81.1% [n = 17] and 23.8% [n = 5], respectively). Of 14 negative culture cases, 9 were treated with early empirical antibiotics (64.3%); 7 patients reported symptomatic improvement (77.8%). Of 5 patients treated with late empirical antibiotics, 4 stated improvement. Patients presented with symptoms akin to resistant postoperative frozen shoulder (persistent pain and stiffness, unresponsive to usual treatments).


Young male patients are at greatest risk for low-grade infections after arthroscopic and open nonarthroplasty shoulder surgery. P. acnes was the most prevalent organism. Patients presented with classic postoperative frozen shoulder symptoms, resistant to usual treatments. Interestingly, 78.6% of patients with negative cultures responded positively to empirical treatment.


Nonarthroplasty; Propionibacterium acnes; arthroscopic; complications; low-grade infection; shoulder

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center