Joint replacement had been a success, but pain persisted in patient’s shoulder
In June 2007, while giving a presentation at a church in Northern Virginia, Harrod fell off a low podium, ripping the cartilage in her shoulder. When three months of physical therapy and painkillers failed, the first orthopaedic surgeon performed an arthroscopic procedure, which allowed him to inspect the joint and make some surgical repairs. He told her that the tear, known to baseball pitchers as a SLAP injury, was worse than first thought and that more extensive surgery might be required. In June 2008, after months of PT, Harrod still had trouble lifting her arm, and the pain remained strong enough to require Vicodin, a narcotic pain reliever. After a second arthroscopy revealed extensive arthritis, the surgeon told Harrod she might need a total shoulder replacement. Her 2009 operation went well, and after about a month in a sling, she started a new round of PT. Although it soon became clear that Harrod’s range of motion was much improved, a deep ache had settled in her upper arm and shoulder, which felt different from the pain she had experienced before the joint replacement. While she could now lift her arm above her head, the normal swinging movement of her arms when she walked hurt. Shoulder specialist recommended that her surgeon leave the joint in place but culture its surfaces and the surrounding tissue to determine if a smouldering infection was present. Harrod’s fifth surgery performed the following month, found nothing amiss. She got a month of intravenous vancomycin, one of the most potent antibiotics available, administered through a central line that was surgically implanted in her upper left arm, but the pain was undiminished. Can you tell what was causing the trouble?
Clue 1: Tests for Lyme disease, lupus and rheumatoid arthritis were all negative
Clue 2: She did not have any drug or latex allergy
Clue 3: No loosened component of the artificial joint was found during Arthroscopic exploration
Clue 4: Both her sed rate and C-reactive protein levels were persistently elevated, which signalled inflammation, but her white count was normal