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Reprint Address: Naveen Poonai, md, London Health Sciences, Children’s Victoria Hospital of Western Ontario, Room E1-105, 800 Commissioners Road East, London, Ontario, N6A 2V5
Affiliations
University of Western Ontario, London Health Sciences, Children’s Hospital of Western Ontario, London, Ontario, Canada
A 3-month-old boy was referred to the Emergency Department for concern of nonaccidental
trauma due to a several-week history of not using the right arm, avoidance of breastfeeding
on the right side, and absence of fever. He was accompanied by both parents and his
grandmother. There was no history of trauma or septic risk factors. The remainder
of the history was noncontributory, including a negative maternal group B streptococcus
status. On examination, the patient was afebrile with normal vital signs. There was
no obvious swelling, redness, or deformity of the right shoulder. There was no active
mobility about the right shoulder joint and passive range of motion appeared painful.
The remainder of physical examination was unremarkable. An x-ray study of the right
shoulder was performed, which confirmed the diagnosis (Figure 1).
Figure 1Anteroposterior x-ray study of right shoulder demonstrates subluxation of the humerus
in relation to the glenohumeral joint. There is associated area of metaphyseal erosion
medially and extending over a distance of 1.06 cm, consistent with osteomyelitis (arrow).
