RESUMO
Background: An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction. Methods: A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case. Results: Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach. Discussion and conclusions: From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.
RESUMO
Background: Inferior angle of scapula fractures (IAS) are rare injuries that result from the periscapular shoulder muscles avulsing the inferior scapula tip. The aim of this study was to investigate the mechanisms of injury, investigations and treatment outcomes, as currently only case reports are available to guide management. Methods: Computered tomography (CT) images were reviewed to identify patients with an IAS fracture. Case notes were reviewed, and patients contacted to gather data relating to the injury, treatment and outcome. Results: Fourteen fractures were identified on CT. Five were missed on the initial radiograph. High energy fractures had an average age of 47.6 years, 90% were male. Low energy fractures had a mean age of 83.6 years 75% were female. All undisplaced fractures had a satisfactory outcome treated non-operatively. Three of six displaced fractures reported an unsatisfactory outcome with non-operative treatment. Subsequent surgical fixation resulted in resolution of symptoms. Conclusions: Inferior angle of scapula fractures are a rare injury that can result from high or low energy trauma. They are easy to miss on plain radiographs. Identification is important as displaced fractures can do poorly when treated non-operatively, but symptoms resolve with surgical fixation. Undisplaced fracture has a satisfactory outcome when treated non-operatively. Evidence: Level IV.
