Dorsal subscapularis approach for the surgical drainage of subscapularis intramuscular abscess: a case report.

BACKGROUND: 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". CASE PRESENTATION: 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. CONCLUSIONS: 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.

Clavicle fracture at the suture hole after acromioclavicular joint reconstruction using a suture-button: a case report.

BACKGROUND: Intraosseous suture-button devices have been used for acromioclavicular joint reconstruction due to its relative simplicity compared with other procedures. However, the complications of acromioclavicular joint reconstruction using a suture-button are not fully understood. Here, we describe a case of a clavicle fracture at the suture hole following acromioclavicular joint reconstruction using a suture-button and hook plate. CASE PRESENTATION: A 28-year-old man presented at our hospital after a fall from his bicycle. The patient had a history of acromioclavicular joint reconstruction with a suture-button and a hook plate for right acromioclavicular joint dislocation, seven months ago at another hospital. The hook plate had been removed four months ago, while X-ray radiography before removal had shown the widening of a suture hole. In the current fall from the bicycle, X-ray radiography revealed a clavicle fracture through the previous drill hole for suture-button. We removed the suture-button and performed an open reduction and internal fixation for the clavicle fracture. CONCLUSION: The present case indicated that a clavicle fracture at the suture hole, although rare, is one of the complications after an acromioclavicular joint reconstruction using a suture-button. This case suggested that drilling to the necessary minimum when making suture holes and paying attention to the widening of suture holes are important to prevent a postoperative clavicle fracture.