612 - Biceps muscle abscess from hardware migration following acute shoulder injury in a patient with remote biceps tenodesis

Case Diagnosis: Biceps muscle abscess from hardware migration after acute shoulder injury in patient with remote biceps tenodesis

Case Description: A 59-year-old male with remote history of arthroscopic rotator cuff repair and biceps tenodesis presented to PM&R clinic after recent emergency department (ED) visits for acute-onset right shoulder pain following a “pop” during heavy lifting one month prior. He was diagnosed with a suspected rotator cuff and biceps tendon injury and referred to sports medicine.
On evaluation, he had diffuse shoulder pain, weakness, and range-of-motion deficits, and a tender, erythematous, fluctuant mid-arm mass overlying the biceps. Radiographs revealed a metallic object in the soft tissues at the site of concern. Same-day labs demonstrated leukocytosis and elevated inflammatory markers.
Given concern for abscess, he was referred back to the ED, where CT confirmed an intramuscular biceps abscess surrounding a migrated tenodesis button. The abscess was irrigated, hardware was removed, and failed biceps tenodesis was managed conservatively.

Discussions: Hardware migration after biceps tenodesis is rare. We present the first documented case of abscess surrounding a migrated biceps tenodesis button after acute tenodesis failure. The exact mechanism of abscess formation is unclear, but may reflect a soft tissue reaction or secondary infection from the migrated button. Without urgent intervention, such an abscess may progress to systemic infection.

Conclusions: This case highlights the importance of evaluating the full clinical presentation. The patient was referred from the ED for acute-onset shoulder pain after lifting a heavy object, but ultimately diagnosed with an abscess of his biceps muscle due to a hardware-related complication from a remote shoulder surgery precipitated by his recent shoulder injury.
Non-surgical musculoskeletal physicians often treat patients with retained hardware from prior surgical interventions. This case highlights the importance of being able to recognize complications that can arise from these prior surgical interventions, to prevent potential life-threatening consequences.