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Arthritis, Septic, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Bacteria can be introduced into a joint by:

    • Hematogenous spread (most common)

    • Invasive procedures

    • Contiguous infection (e.g., osteomyelitis, cellulitis)

    • Direct inoculation such as plant ...

Diagnosis

Signs and Symptoms

  • Presents abruptly as a single painful, swollen, warm, tender joint

  • Common findings include:

    • Fever

    • A separate source of infection (e.g., skin)

    • Extremely painful joint motion in ...

Treatment

Pre-Hospital

No specific considerations 

Initial Stabilization/Therapy

  • Patient may be septic and require resuscitation.

  • If patient is toxic, do not delay antibiotics for aspiration results.

Ed Treatment/Procedures

Follow-Up

Disposition

Admission Criteria

  • All patients with suspected SA should be admitted until SA is ruled out.

  • May undergo drainage of joint, as indicated, by serial aspirations, arthroscopy, or arthr...

Pearls and Pitfalls

  • CRP and ESR can be used to follow up response to treatment

  • It can be difficult to distinguish SA from toxic synovitis or crystal arthropathy; have a low threshold for arthrocentesis...

Additional Reading

  • Carpenter  CR, Schuur  JD, Everett  WW, et al. Evidence-based diagnostics: Adult septic arthritis. Acad Emerg Med.  2011;18:781–796.

  • Coakley  G, Mathews  C, Field  M, et al. BSR...

Codes

ICD9

  • 711.00 Pyogenic arthritis, site unspecified

  • 711.05 Pyogenic arthritis, pelvic region and thigh

  • 711.45 Arthropathy associated with other bacterial diseases, pelvic region and thigh

ICD10

  • M00.9 Py...

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