Septic arthritis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Patients with septic arthritis usually appear toxic.Common physical examination findings of septic arthritis include erythema, warmth, swelling, tenderness and decreased range of motion over the affected joint, usually knee.

Physical Examination

Appearance of the Patient

• Patient with septic arthritis usually appears toxic and with joint pain
• children usually appear irritable

Vital Signs

• Low grade fever. Chills and spiking fever are very rare.
• Hyperthermia over the joint involved
• Tachycardia
• Tachypnea

Skin

• Warmth over the joint

• Erythema over the around the joint that involved
• 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.

Extremities

Most commonly involves knee > hip > shoulder > ankle. 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.

• Swelling of the joint that involved
• Decreased range of motion such as pseudo paralysis
• Patient hold the hip in flexed and externally rotated position if SA involving hip.
• If child, unwillingness to bear weight on the affected joint (antalgic gait)