Neonatal Proximal Humerus Osteomyelitis: A Case Report and Literature Review

Abstract

Objective − This case report was written with the purpose of educating neonatal caregivers with regard to the early detection of osteomyelitis in order to start treatment quickly and avoid the devastating consequences later with lifelong disability.

Case Report − We present a 20-day-old newborn with a lack of spontaneous movement of the right arm, which first occurred 5 days prior. The newborn was diagnosed with Erb’s palsy, and physiotherapy was started. Upon re-examination, he did not move his right arm, his shoulder was slightly swollen, he was afebrile, and C-reactive protein was elevated. The initial radiographic finding was normal, but the ultrasound evaluation found evidence of proximal humerus osteomyelitis. Over the next two days, the condition did not improve despite the included therapy (vancomycin and amikacin). Then, joint drainage surgery was performed. The radiographic finding upon discharge showed significant destruction of the proximal humerus and shoulder joint. At the age of 12 months, the range of motion in the affected shoulder joint was less than in the left.

Conclusion − Regular arm mobility in the early postpartum days, pseudoparalysis on examination, a swollen and raised shoulder, pain during passive movements, a positive ultrasound examination, and a high level of C-reactive protein are data that can reliably indicate the onset of osteomyelitis of the proximal humerus and help in the differential diagnosis between osteomyelitis and Erb’s palsy. The lack of timely diagnosis of osteomyelitis and the delayed inclusion of therapy can lead to late consequences, such as significant destruction of the proximal humerus and the shoulder joint.