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| Septic arthritis resident survival guide:
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| === Complete diagnostic approach: ===
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| <div style="font-size: 90%;">
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| {{Familytree/start}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| A01 | | |A01=<div style="padding: 10px;">
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| ==Common Presentation==
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| '''Symptoms in newborns or infants:'''
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| * Cries when infected joint is moved (e.g. diaper change causes crying if hip joint is infected)
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| * [[Fever]]
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| * Inability to move the limb with the infected joint (pseudoparalysis)
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| * [[Irritability]]
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|
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| '''Symptoms in children and adults:'''
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| * Inability to move the limb with the infected joint (pseudoparalysis)
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| * Intense [[joint pain]]
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| * Joint [[swelling]]
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| * Joint redness
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| * Low [[fever]]
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| * The [[tenosynovitis]] is characterized by pain, [[swelling]], and [[erythema]] around the tendon
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| ==Less common Presentation==
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| *[[Chills]]
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| </div>}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| A01 | | |A01=<div style="padding: 10px;">
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| ==Focused History==
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| * Intravenous drug use
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| * Sexual activity
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| * Terminal complement deficiency
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| * Dog or cat bite
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| * Ingestion of unpasteurized dairy products
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| * Nail through shoe
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| * Soil exposure/gardening
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| * Soil or dust exposure containing decomposed wood
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| (north-central and southern United States)
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| * Southwestern United States, Central and South America
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| (primary respiratory illness)
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| * Cleaning fish tank
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| </div>}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| |!| | | |}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| A01 | | |A01=<div style="padding: 10px;">
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| ==Physical Examination==
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|
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| ===Appearance of the Patient===
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| * Patient with [[septic arthritis]] usually appears [[toxic]] and with [[joint pain]]
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| * children usually appear [[irritable]]
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|
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| === Vital Signs ===
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| * Low grade [[fever]]. [[Chills]] and spiking fever are very rare.
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| * [[Hyperthermia]] over the joint involved
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| * [[Tachycardia]]
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| * [[Tachypnea]]
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|
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| === Skin ===
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| * Warmth over the joint
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|
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| * [[Erythema]] over the around the joint that involved
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| * [[Disseminated gonococcal infection]] often present with [[skin]] lesions, typically multiple, painless [[macules]] and [[papules]], most often found on the arms or legs or on the [[trunk]].<ref name="pmid9449882">Goldenberg DL (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9449882 Septic arthritis.] ''Lancet'' 351 (9097):197-202. [http://dx.doi.org/10.1016/S0140-6736(97)09522-6 DOI:10.1016/S0140-6736(97)09522-6] PMID: [https://pubmed.gov/9449882 9449882]</ref>
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|
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| === Extremities ===
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| Most commonly involves [[knee]] > [[hip]] > [[shoulder]] > [[ankle]].<ref name="pmid3498362">Barton LL, Dunkle LM, Habib FH (1987) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3498362 Septic arthritis in childhood. A 13-year review.] ''Am J Dis Child'' 141 (8):898-900. PMID: [https://pubmed.gov/3498362 3498362]</ref> Other joints such as [[sacroiliac joint]] (~10%), [[sternoclavicular]] or costoclavicular joints may be involved in patient with history of intravenous drug abuse (IVDA), penetrating trauma, animal or human bites and local [[steroid]] [[injections]].
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| * [[Swelling]] of the joint that involved
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| * Decreased [[range of motion]] such as pseudo paralysis
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| * Patient hold the hip in flexed and externally rotated position if SA involving [[hip]].
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| * If child, unwillingness to bear weight on the affected joint (antalgic gait)
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|
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| </div>}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| |!| | | |}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| A01 | | |A01=<div style="padding: 10px;">
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| ==Laboratory Workup==
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| * [[Complete blood count|CBC with DC]]
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| * [[Basic metabolic panel|SMA-7]]
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| * [[Creatine kinase]]
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| * [[Urinalysis]] with [[Urinalysis#Microscopic examination|microscopic examination]]
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| * [[Erythrocyte sedimentation rate]]
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| * [[C-reactive protein]]
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| * Synovial fluid analysis
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| **Synovial [[White blood cells|WBC]] count with differential
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| **Crystal analysis
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| **[[Gram staining|Gram stain]]
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| **Culture and sensitivity
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| </div>}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| |!| | | |}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| A01 | | |A01=<div style="padding: 10px;">
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| ==Imaging Study==
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|
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| ===Plain radiographs of swollen joints===
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| *[[Swelling]] of the joint capsule and soft tissue around the joint
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| * Fat pad displacement
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| *Joint space widening due to localized [[edema]] and effusion.<ref name="pmid7618566">Jaramillo D, Treves ST, Kasser JR, Harper M, Sundel R, Laor T (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7618566 Osteomyelitis and septic arthritis in children: appropriate use of imaging to guide treatment.] ''AJR Am J Roentgenol'' 165 (2):399-403. [http://dx.doi.org/10.2214/ajr.165.2.7618566 DOI:10.2214/ajr.165.2.7618566] PMID: [https://pubmed.gov/7618566 7618566]</ref><ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref><ref name="pmid21916390">Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML (2011) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21916390 Approach to septic arthritis.] ''Am Fam Physician'' 84 (6):653-60. PMID: [https://pubmed.gov/21916390 21916390]</ref>
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|
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| ===Computed tomography (CT)===
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| *Visualization of joint effusion
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| * Soft tissue swelling
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| * Para-articular [[abscesses]]
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| * Joint space widening due to localized edema, bone erosions, foci of osteitis, and scleroses.<ref name="pmid6725696">Seltzer SE (1984) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6725696 Value of computed tomography in planning medical and surgical treatment of chronic osteomyelitis.] ''J Comput Assist Tomogr'' 8 (3):482-7. PMID: [https://pubmed.gov/6725696 6725696]</ref><ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref>
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| ===Magnetic resonance imaging (MRI)===
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| *[[Synovial]] enhancement
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| *Perisynovial [[edema]]
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| *Joint effusion
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| *Signal abnormalities in the bone marrow
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| </div>}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| |!| | | |}}
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| {{Familytree|boxstyle=width: 700px; text-align: left; font-size: 100%; padding: 0px;| A01 | | |A01=<div style="padding: 10px;">
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| ==Other Investigation==
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| === PCR===
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| === Arthrocentesis ===
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| * In the presence of joint effusion to differentiate between different causes of [[arthritis]]<ref name="pmid642792">{{cite journal |vauthors=Goldenberg DL, Cohen AS |title=Synovial membrane histopathology in the differential diagnosis of rheumatoid arthritis, gout, pseudogout, systemic lupus erythematosus, infectious arthritis and degenerative joint disease |journal=Medicine (Baltimore) |volume=57 |issue=3 |pages=239–52 |year=1978 |pmid=642792 |doi= |url=}}</ref>
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| </div>}}
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| {{Familytree/end}}
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| </div>
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