Infections of the upper limb

Osteomyelitis

Osteomyelitis of the upper limb is very uncommon in adults, unless there are specific predisposing factors such as penetrat­ing wounds. As with other sites, staphylococci and streptococci are commonly implicated, although in the immunocompromised patient other organisms may be encountered. The treatment of osteomyelitis of the upper limb does not differ from other sites.

In children, osteomyelitis of the proximal humeral metaphysis can occur but this is much less common than osteomyelitis of the proximal femur or around the knee.

Septic arthritis

In both adults and children, septic arthritis of the shoulder or elbow is uncommon. Arthroscopy is preferred to formal arthrotomy for washing out the shoulder. The elbow may be washed out arthroscopically or via a lateral Kocher-type approach.

  Tuberculosis

The shoulder and elbow are relatively uncommon sites for tuberculosis (TB) and treatment is along conventional lines. Secondary degeneration can occur and may be difficult to manage. A previously infected joint is one of the few indications for shoulder arthrodesis but the elbow presents a dilemma. Arthrodesis of the elbow is not a good procedure and there is little information on the outcome of other methods of treatment after previous TB.