Sepsis of the shoulder joint occurs most commonly as a result of penetrating injury. Diagnosis and treatment proceed as for other joints. In foals (and rarely, weanlings or yearlings) infection can spread hematogenously and become established in the growth plates or ends of the bones (physeal or epiphyseal infection). These infections, provided they are not associated with contamination of the synovial structures, can be treated with high levels of antimicrobials systemically before resorting to surgical intervention. Methods to provide high quantities of antimicrobials at the site of infection exist (eg, intraosseus perfusion).