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wrist septic arthritis management

Edward Carlin, Colleen Urban, Jessica Sidle, Angela Cirilli, Jennifer Larson, Mark Richman, Daniel Dexeus
BACKGROUND: Gonorrhea is the second most common sexually transmitted infection. Disseminated gonococcal infection (DGI) consists of gonococcal infection plus one or more of the triad of arthritis, tenosynovitis, and dermatitis. Diagnosis in the emergency department (ED) must be suspected clinically, as confirmatory tests are often not available. Point-of-care ultrasound (POCUS) can aid in diagnosis and appropriate management by identifying tenosynovitis and excluding arthritis. CASE REPORT: A 26-year-old man with multiple recent sex partners presented to the ED with slowly progressing right wrist pain and swelling over 5 days...
April 20, 2018: Journal of Emergency Medicine
John D Jennings, Asif M Ilyas
Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Timely identification and treatment is critical to patient care. No serum laboratory values have been shown to consistently confirm wrist joint infection. Thus, diagnosis is made based mainly on a thorough patient history, physical examination, and joint aspiration. When infection is suspected, aspiration of the wrist should be performed to confirm the diagnosis. Broad-spectrum antibiotics and joint aspiration or surgery are required to manage the infection and prevent sequelae...
February 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
W A N V Luke, M P M L Gunathilake, Duminda Munidasa, Dilshan Munidasa, S T De Silva
BACKGROUND: Unusual forms of tuberculosis are common among immune-suppressed patients, leading to challenges in diagnosis and management. We present a Sri Lankan patient with systemic lupus erythematosis, investigated for chronic wrist pain with low inflammatory markers and without systemic symptoms, who was subsequently diagnosed to have tuberculosis of the joint. CASE PRESENTATION: A 31-year-old woman with systemic lupus erythematosis in remission was evaluated for chronic left wrist pain without significant examination findings on presentation...
July 28, 2017: BMC Research Notes
Adam M Wegner, Nicole Look, Brian M Haus
In the United States, rat-bite fever is a rare systemic illness principally caused by Streptobacillus moniliformis, an organism found in the nasopharyngeal flora of rodents. Infection through direct exposure to rat excreta such as saliva, urine, or feces can lead to fever, rash, and an asymmetric migratory polyarthritis. As rodents are becoming more popular as pets, more pediatric cases are being documented. We report a pediatric case of delayed onset septic arthritis in the left wrist and right knee due to S...
2017: Case Reports in Orthopedics
Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
June 2017: Annals of Plastic Surgery
S Ahlawat, F M Corl, D M LaPorte, E K Fishman, L M Fayad
Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Deep hand infections are located deep to the tendon sheaths and include synovial space infections, such as infectious tenosynovitis, deep fascial space infections, septic arthritis, necrotising fasciitis, and osteomyelitis...
April 2017: Clinical Radiology
T J Kowalski, L A Thompson, J D Gundrum
PURPOSE: The optimal antimicrobial treatment for patients with hand or wrist septic arthritis is unknown. We report the treatment outcomes in patients with these infections. METHODS: The medical records of 40 consecutive adult patients with hand or wrist septic arthritis treated at our institution from 2000 to 2008 were retrospectively reviewed. The primary outcome measure was treatment failure (histopathologic or microbiologic evidence of relapsed infection from the same joint or a contiguous anatomic area)...
April 2014: Infection
A Hariri, F Lebailly, A Zemirline, S Hendriks, S Facca, P Liverneaux
Septic arthritis of the wrist is a diagnostic and therapeutic emergency. Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose of this study was to evaluate the diagnostic and therapeutic contribution of emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were operated on for wrist pathology with septic appearance. All had signs of local inflammation, three showed locoregional inflammation, three were febrile. In one patient several joints were involved. Seven patients presented with inflammatory or degenerative arthritis...
September 2013: Chirurgie de la Main
Douglas M Sammer, Alexander Y Shin
Bacterial septic arthritis of the wrist is a joint-threatening emergency that is often treated by open irrigation and debridement (I and D). There is evidence that patients with isolated septic arthritis of the wrist require fewer operations and have a shorter hospital stay when treated arthroscopically. This article describes the surgical technique for arthroscopic I and D of the wrist and discusses the indications and benefits of arthroscopic versus open I and D for septic arthritis of the wrist.
August 2011: Hand Clinics
Matthew J Reed, Andrew Carachi
AIM: To audit the management of nontraumatic hot swollen joints presenting to a large UK university teaching hospital and to design a simple emergency department (ED) algorithm to improve patient care based on existing guidelines and our experience. METHODS: Prospective audit. RESULTS: Between 2 February and 8 May 2009, 77 patients were enrolled. Median age was 58 years (range 19-89 years) and 57% were male patients. The most commonly affected joint was the knee (38%), with the knee, wrist, ankle, hip and elbow comprising 87% of affected joints...
April 2012: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Michael V Birman, Robert J Strauch
No abstract text is available yet for this article.
February 2011: Journal of Hand Surgery
Douglas M Sammer, Alexander Y Shin
BACKGROUND: Open irrigation and débridement is the standard of treatment for septic arthritis of the wrist. Although isolated cases of arthroscopic irrigation and débridement have been reported, a comparison of arthroscopic and open techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of management. METHODS: A retrospective comparison of patients with septic arthritis of the wrist initially treated, over an eleven-year period, with open or arthroscopic irrigation and débridement was undertaken at a single institution...
March 2010: Journal of Bone and Joint Surgery. American Volume
Douglas M Sammer, Alexander Y Shin
BACKGROUND: Open irrigation and débridement is the standard of treatment for septic arthritis of the wrist. Although isolated cases of arthroscopic irrigation and débridement have been reported, a comparison of arthroscopic and open techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of management. METHODS: A retrospective comparison of patients with septic arthritis of the wrist initially treated, over an eleven-year period, with open or arthroscopic irrigation and débridement was undertaken at a single institution...
June 2009: Journal of Bone and Joint Surgery. American Volume
Christopher Hoe-Kong Chui, Jonathan Yi-Liang Lee
BACKGROUND: Gout is known to mimic conditions as diverse as joint and soft tissue infections, skin malignancies, nerve compression syndromes and soft tissue tumours. Upper limb involvement is unusual. OBJECTIVE: We discuss four cases of gout in the hand and wrist masquerading as a soft tissue tumour, nodular extensor tenosynovitis, septic arthritis of the wrist and acute and chronic median nerve compression. These cases illustrate that gout in the hand and wrist can resemble more sinister conditions, often posing a diagnostic challenge even to the experienced clinician...
November 2007: Australian Family Physician
Yong Yeow Chong, Kok Yong Fong, Julian Thumboo
INTRODUCTION: Although joint aspiration with synovial fluid analysis is useful in the diagnosis of crystal or septic arthritis, the frequency with which it provides a diagnosis or aids subsequent management of patients with arthritis has not been well quantified. We therefore evaluated the usefulness of joint aspiration in the diagnosis and management of patients with arthritis in a hospital-based rheumatology service. MATERIALS AND METHODS: We reviewed records of all patients with joint aspiration performed by an inpatient rheumatology service in a tertiary referral hospital from November 2003 to December 2004...
February 2007: Annals of the Academy of Medicine, Singapore
N J Bureau, R K Chhem, E Cardinal
One of the most important prognostic factors in patients with musculoskeletal infections is the delay in establishing therapy. Early diagnosis of septic arthritis requires analysis of joint fluid. Ultrasonography (US) is a rapid, portable, sensitive technique for confirming the presence of joint effusions. The study can be easily repeated for follow-up of lesions. US allows real-time guidance of fluid aspiration and can reduce the risk of contaminating other anatomic compartments, especially in the hands, wrists, and feet...
November 1999: Radiographics: a Review Publication of the Radiological Society of North America, Inc
N Levi, J Peterson, C F Larsen, A Hede
In this paper we report a 48-year-old man with septic arthritis of the wrist and ankle due to Streptococcus pneumoniae. No known predisposing factor was found. Only about 300 cases of pneumococcal arthritis have been reported in the literature since 1888 and less than 10% of these affect the wrist. The management of bacterial arthritis is reviewed.
June 1999: Panminerva Medica
T B Burt, D K MacCarter, M I Gelman, C O Samuelson
Although synovial cysts are most commonly associated with rheumatoid arthritis and osteoarthritis, they may occur in many other conditions. The clinical manifestations of these cysts are numerous and may result from pressure, dissection or acute rupture. Vascular phenomena occur when popliteal cysts compress vessels, and result in venous stasis with subsequent lower extremity edema or thrombophlebitis. Rarely, popliteal cysts may cause arterial compromise with intermittent claudication. Neurological sequelae include pain, paresthesia, sensory loss, and muscle weakness or atrophy...
August 1980: Western Journal of Medicine
J Prévot, P Lascombes, D Mainard, J N Ligier, J P Metaizeau
For 25 years, 102 hematogenous septic arthritis have been observed in 82 newborns and infants. The hip joint was the most commun site of involvement (63 cases), than the knee (23 cases), the shoulder (7 cases), the elbow (5 cases), the ankle (3 cases) and one wrist. 14 times, two or more joints were involved. When the diagnosis was made early, an aspiration of pus and an irrigation of the joint was done. But in severe and delayed arthritis, an arthrotomy was preferred. In all cases, joints were immobilized in a post-operative cast or with a traction management, and parenteral antibiotics were prescribed...
1985: Chirurgie Pédiatrique
P Barss, S Ennis
Pigs are intelligent animals that can be formidable adversaries to humans because of their sharp tusks and their ability to attack swiftly. Domestic and feral pigs have an important role in the ecology of village life in Melanesia. A six-year review of all injuries that were caused by pigs that were referred from the villages in Milne Bay Province, Papua New Guinea, to the Provincial Hospital was completed. Some of the injuries that were seen among the 20 patients who were studied included: three penetrating abdominal injuries with prolapse and strangulation of the intestine; a "sucking" chest wound; bilateral pneumothoraces; two infected open fractures of the radius and the ulna; a perforating injury of the knee with septic arthritis; a hand injury with laceration of multiple tendons; an arterial injury of the wrist; injury of a tibial nerve with foot drop; and a severe scrotal injury with exposure of the testicles...
December 5, 1988: Medical Journal of Australia
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