{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:40:01Z","timestamp":1756377601908,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,17]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>The early diagnosis of low-grade <jats:italic>Cutibacterium acnes<\/jats:italic> prosthetic shoulder joint infection is challenging due to the lack of clinical and laboratory signs. Patients present with atypical symptoms such as stiffness or failure to improve shoulder function. The diagnosis is often delayed with impact on long-term outcomes. We present the case of an 82-year-old man with a surgical site erythema occurring 7\u2009weeks after reverse shoulder arthroplasty associated with a light raise of C reactive protein (20\u2009mg\/L). At 9\u2009weeks, radiographs revealed a \u2018periosteal spur sign\u2019 (humeral calcar) and localised adjacent osteolysis. Open surgery showed morphological signs of infection confirmed by growth of <jats:italic>C<\/jats:italic>. <jats:italic>acnes<\/jats:italic> in eight cultures. A \u2018periosteal spur sign\u2019 is a useful early radiographic indicator of low-grade prosthetic joint infection usually occurring with some delay after clinical symptoms. A high clinical index of suspicion is needed to proceed with biopsies and to initiate combined operative and antibacterial treatment.<\/jats:p>","DOI":"10.1136\/bcr-2020-239020","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T15:38:25Z","timestamp":1659109105000},"page":"e239020","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Humeral periosteal spur sign with osteolysis as an early radiographic indicator of low-grade <i>Cutibacterium acnes<\/i> prosthetic shoulder infection"],"prefix":"10.1136","volume":"14","author":[{"given":"Stefan","family":"Bauer","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, EHC, Morges, Vaud, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Dietz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Spine Surgery, St Josefs Hospital, Wiesbaden, Hessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrej","family":"Trampuz","sequence":"additional","affiliation":[{"name":"Charit\u00e9 - Universit\u00e4tsmedizin, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, EHC, Morges, Vaud, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"2025082803175763000_14.3.e239020.1","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/j.jse.2014.12.036","article-title":"Infection after primary anatomic versus primary reverse total shoulder arthroplasty","volume":"24","author":"Florsch\u00fctz","year":"2015","journal-title":"J Shoulder Elbow 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