Pyogenic arthritis of the shoulder in adults.

The cases of fifteen patients with sixteen septic glenohumeral joints were evaluated. In each of the patients there was at least one predisposing factor, and each patient was treated by either repeated aspiration (eleven shoulders) or arthrotomy (five shoulders), combined with parenteral antibiotics. The most significant factors leading to poor results of treatment were delay in instituting treatment, virulence of the infecting organism, and a serious underlying disease process. In eight of ten shoulders in which treatment was begun four weeks or less after symptoms appeared, a satisfactory functional outcome was obtained, while all six patients who were treated after a delay of more than four weeks had poor results. All six patients infected with Streptococcus or coagulase-negative Staphylococcus had satisfactory results. Two of the eight patients with Staphylococcus aureus or gram-negative organisms also had a satisfactory result, while the other six did not. The two successfully treated patients with Staphylococcus aureus were diagnosed within three days of the onset of symptoms, whereas the others had delays in instituting treatment.