Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
BMC Musculoskelet Disord. 2019 Oct 12;20(1):445. doi: 10.1186/s12891-019-2852-1.
Abscess formation in the subscapularis muscle is a rare clinical condition. Few reports are available regarding the treatment methods and surgical approaches for subscapularis intramuscular abscesses. Here, we describe a case of subscapularis intramuscular abscess that was treated successfully via surgical drainage using a new approach, the "dorsal subscapularis approach".
A 67-year-old woman presented to our hospital with complaints of fever and disturbance of consciousness. Two days prior to visiting our hospital, right shoulder pain and limited range of motion in the shoulder were noted. Cerebrospinal fluid examination and contrast-enhanced computed tomography (CT) imaging on admission revealed a right subscapularis intramuscular abscess with concomitant bacterial meningitis. The patient's clinical symptoms improved after antibiotic administration for 3 weeks, but the right shoulder pain persisted. Contrast-enhanced CT imaging performed after antibiotic administration revealed an abscess in the right shoulder joint space, in addition to a capsule of the abscess in the right subscapularis muscle. We performed open surgical drainage for the abscess, which had spread from the subscapularis muscle to the glenohumeral joint. Using the deltoid-pectoral approach, we detected exudate and infected granulation tissue in the joint cavity. Furthermore, we separated the dorsal side of the subscapularis muscle from the scapula using a raspatory and detected infected granulation tissue in the subscapularis muscle belly. We performed curettage and washed as much as possible. After surgery, antibiotic administration continued for 2 weeks. The patient's right shoulder pain subsided and CT performed 2 months after surgery revealed no recurrence of infection.
The present case indicated that a subscapularis intramuscular abscess could lead to severe concomitant infections of other organs via the hematogenous route. Thus, early detection and treatment are necessary. Moreover, in this case, surgical drainage using a dorsal subscapularis approach was beneficial to treating the abscess, which had spread from the subscapularis muscle to the glenohumeral joint.
肩胛下肌脓肿是一种罕见的临床病症。目前仅有少数关于肩胛下肌肌间脓肿的治疗方法和手术入路的报道。在此，我们报告一例肩胛下肌肌间脓肿病例，该病例采用一种新的手术入路——“肩胛下肌背侧入路”成功进行了切开引流。
一名 67 岁女性因发热和意识障碍就诊于我院。在来我院就诊前两天，患者出现右肩部疼痛和肩关节活动度受限。入院时行脑脊液检查和增强 CT 检查提示存在右肩胛下肌肌间脓肿合并细菌性脑膜炎。患者经 3 周抗生素治疗后临床症状改善，但右肩部疼痛仍持续存在。抗生素治疗后行增强 CT 检查提示右肩关节腔内脓肿形成，同时肩胛下肌肌间脓肿形成包膜。我们对脓肿进行了开放性切开引流，脓肿已经从肩胛下肌扩展至盂肱关节。采用三角肌胸大肌入路，我们在关节腔内发现渗出物和感染性肉芽组织。另外，我们使用骨锉将肩胛下肌的背侧与肩胛骨分离开，发现肩胛下肌肌腹内有感染性肉芽组织。我们进行了刮除和尽可能的冲洗。术后继续应用抗生素 2 周。患者右肩部疼痛缓解，术后 2 个月行 CT 检查未见感染复发。
本例肩胛下肌肌间脓肿可能通过血行途径导致其他器官严重合并感染，因此需要早期发现和治疗。此外，在本例中，采用肩胛下肌背侧入路切开引流有利于治疗从肩胛下肌扩展至盂肱关节的脓肿。
