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Infected synovial fluid color1/2/2024 Classically, the presence of generalized tenderness with painful limitation of both active and passive range of motion often indicates true joint involvement (3). This can be difficult to differentiate on exam as joint effusions may not be readily identified on exam, and patients with bursitis may present with inflammation that mimics septic arthritis. Careful examination should attempt to determine whether the inflammation is located in the joint capsule (intra-articular) or in the surrounding soft tissue structures (peri-articular) including the bursa, tendons, and skin. osteoarthritis or gout arthropathy) with similar pain and successful treatment regimens can aid in decision-making and support non-infectious etiologies.Ī joint should be examined for obvious deformity, injury, warmth, tenderness, effusion, stability, laxity, range of motion, and pain during both active and passive movement. Exacerbations of pre-existing disease (e.g. Although patients are often unreliable in this regard, sudden onset of pain and rapid progression can indicate infection or crystal-induced pathology, while a more protracted course may indicate a less destructive process. It is important to establish both a time of onset and progression of symptoms. In contrast, only 50% of patients were found to be febrile, making the presence of fever a poor indicator of septic arthritis (2). A recent review found that in patients diagnosed with septic arthritis, 80% endorsed pain in the joint. Patients typically present with a constellation of symptoms including pain, tenderness, swelling, warmth, redness, fever, painful or limited range-of-motion, and immobility. TABLE 1: Risk Factors for Septic Arthritis (2,3):Īlthough history alone cannot reliably identify or exclude a septic joint, all patients with a joint-related complaint should receive an age-appropriate, targeted history aimed at identifying risk factors associated with septic arthritis (TABLE 1). Predisposing risk factors for developing septic arthritis underscore these three routes of entry and can be found in TABLE 1. Differentiating the source of inflammation or pain as articular (within the joint) or periarticular (outside the joint) is an important step in preventing iatrogenic inoculation. Other causes of septic arthritis include direct inoculation from either penetrating trauma or iatrogenic introduction of bacteria during procedural intervention and contiguous spread of a local infection including osteomyelitis, septic bursitis, and/or abscess. The migration of bacteria into a joint is facilitated by the lack of a basement membrane (or barrier) in the synovial tissues. The most common source of infection is hematogenous spread of bacteria from bacteremia. A predilection for large joints exists with as many as 60% of cases involving the knee or the hip (1). Septic arthritis typically involves one joint, but can be polyarticular in up to 20% of cases. Bacterial arthritis, often used synonymously with septic arthritis, portends the most destructive course and should therefore bear weight on a clinician’s diagnostic considerations. In the absence of trauma, the differential is broad ranging from benign to potentially life-threatening. The presentation of an acutely painful, warm, and/or swollen joint requires emergent evaluation. Heimann, MD (EM Resident Physician, University of Alabama at Birmingham Hospital) and Kevin Barlotta, MD (Attending Physician and Associate Professor of EM, University of Alabama at Birmingham Hospital) // Editors: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (EM Resident Physician at SAUSHEC USAF)įeatured on #FOAMED REVIEW 46TH EDITION – Thank you to Michael Macias from emCurious ( for the shout out!
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