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    What do my lab test reports indicate?

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Posted on Fri, 21 Jul 2017 in Bones, Muscles and Joints
Question: Hi I had 2 shoulder stabilisations in 2015 (same shoulder) for a bankart tear. Last year I had sudden and worsening pain, and a biopsy showed p.acnes infection. I subsequently had the sutures removed from my anchors, a thorough wash out, and 6 months of antibiotics. The anchors were retained as they were in tight. I am 8 months out from that procedure and the infectious disease doctor has been unable to get rid of the infection and believes it is in the anchors. My crp is consistently between 22 and 34.
I've been to my surgeon and he believes the p.acnes in the anchors is causing my persistent pain, but wants me to see a colleague to review my scans to make sure he's not missing something else. I have to wait 4 weeks to see this other surgeon for a second opinion, but I was asked to get a plain xray prior to seeing him. I've had that xray and it's clear there is a small object in my shoulder. The report says there is a surgical anchor seen just below the coracoid process, as well as degenerative changes in the glenohumeral joint. I'm not an expert, but I think the anchor has moved? Could you please have a look at the xrays and tell me if the anchor is where it should be? I have 3 in the front and bottom of the glenoid, and to me it looks way out of place. If it has moved I think this is the confirmation my surgeon needs to be sure there is an infection in the anchor sites. He has previously said the anchors would be loose if there was an infection, you can't get much looser than it moving!
I see the new surgeon in 4 weeks, and my regular surgeon in 5 weeks, but in light of this xray I'm wondering if I should let my surgeon know about this finding which will perhaps mean I don't have to wait another month in agony waiting for a second opinion.The xray report was not sent to my regular surgeon, do you think this warrants following up with him? Is it safe to have an anchor floating around?
I did also have an mri and CT on the same day, but those reports don't mention any anchors. My understanding is that the anchors I have are plastic and don't show on imaging, so I'm not sure if that's why a stray anchor may not show on those scans?
My question today is specifically about the xray and if it looks like an anchor has moved. The xray referral didn't mention what previous surgery I have had, it just said ongoing pain. As such the radiologist wouldn't have known where the anchor is meant to be. Should glenoid anchors be showing up below the coracoid process?
I don't want to raise this with my surgeon if this is normal anchor placement, however, if there is an anchor floating around I'd rather getting it sorted sooner rather than later to avoid any extra damage.
doctor
Answered by Dr. Aashish Raghu 35 minutes later
Brief Answer:
The anchor is well in its place

Detailed Answer:
Hi there

Thanks for the query

I have read your query and viewed the attached reports.

I was able to spot a single anchor. It is definitely in its place and not below the coracoid as mentioned to you. The suture anchor in the AP view appears like it is under the coracoid but after seeing the Axial view, it is well near the glenoid in the scapula where it should be.

It is best to inform your regular Doctor as well about your condition and the latest developments.

Sometimes calcification can occur over the implant and they can be seen on the Xray.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr.Aashish Raghu
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Aashish Raghu 7 hours later
Thank you for your answer. I've had two doctors on other sites say the complete opposite, so I'm very confused at the different interpretations. They both mentioned that 2 anchors can be seen dislodged, this was after viewing the mri and CT images which are also attached.
doctor
Answered by Dr. Aashish Raghu 5 hours later
Brief Answer:
Need the immediate post op Xray to compare

Detailed Answer:
As far as as the right placement of the anchors are concerned there doesn't soar to be any malplacement.

It would be helpful if you could upload your immediate post op Xray for comparison.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Aashish Raghu 22 minutes later
I didn't have any X-rays immediately after surgery. Thanks for your time anyway, I'll just wait until I see my surgeon in person.
doctor
Answered by Dr. Aashish Raghu 1 hour later
Brief Answer:
Get well soon

Detailed Answer:
Thank you. Wishing you a speedy recovery.
Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5194 Questions

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