Nonspecific findings include restricted motion that is usually only mildly painful. Although they are sometimes difficult to detect depending on the patient's size, joint effusions of the shoulder are always present. In the case of our patient, systemic symptoms may have been suppressed by the oral corticosteroids. Radiographic findings can include inferior subluxation of the humeral head, soft-tissue swelling, joint effusion, demineralization, loss of joint space, superior subluxation, and subchondral osseous erosion. Further diagnostic imaging may be necessary at times when the clinical diagnosis is unclear or does not fit the patient's symptoms.
Diagnosis is confirmed with joint aspiration, synovial fluid analysis, and culture.
It should be noted that synovial fluid analysis can be unreliable and inconsistent with clinical findings, as it was in our patient, in whom only the neutrophil count was significant. Treatment strategies have evolved over the years. Outcome depends on many variables, including time of diagnosis, virulence of the organism, appropriateness of treatment, and health of the patient. When to Be Suspicious Glenohumeral septic arthritis should always be suspected in very young or elderly patients who are immunocompromised and experience painful loss of shoulder motion possibly accompanied by vague systemic symptoms. The index of suspicion should also be raised when a healthy young person reports similar complaints that are inconsistent with physical findings or treatment response.