1
|
Oswald A, Alorda A, Tassone M, Walker A, Ganti L. Acromioclavicular Osteomyelitis: When Simple Cellulitis Is No Longer Simple. Orthop Rev (Pavia) 2022. [DOI: 10.52965/001c.36909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this case report is to highlight the importance of continued examination and evaluation to correctly diagnose and treat the rare condition of acromioclavicular osteomyelitis and associated septic arthritis. A 51-year-old diabetic male presented with right shoulder pain and overlying cellulitis without history of trauma, intravenous (IV) drug use, lacerations, prostheses or endocarditis later developed septic arthritis and osteomyelitis of the acromion and distal clavicle requiring operative management. Decision to re-image the joint using magnetic resonance imaging (MRI) with contrast after lack of symptomatic improvement was key to making the diagnosis.
Collapse
Affiliation(s)
- Adam Oswald
- University of Central Florida College of Medicine
| | | | | | | | - Latha Ganti
- University of Central Florida College of Medicine
| |
Collapse
|
2
|
Thomas J, Daud M, Macmull S. Acute septic arthritis of the acromioclavicular joint caused by Staphylococcus aureus with marked soft tissue collection towards posterior medial aspect of the AC joint: A rare clinical presentation. IDCases 2022; 29:e01513. [PMID: 35663610 PMCID: PMC9160752 DOI: 10.1016/j.idcr.2022.e01513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Primary septic arthritis of the Acromioclavicular joint is an unusual disorder and is seldom seen even in an immunocompromised person. We report a case of primary septic arthritis of the acromioclavicular (A-C) joint caused by Staphylococcus aureus. The patient was admitted with pain in the left shoulder, restricted movements and fever. Laboratory parameters showed elevated C-reactive protein, raised erythrocyte sedimentation rate and leukocytosis. Ultrasound revealed a 32 mm collection at the acromioclavicular joint. Patient underwent incision and drainage of abscess. Culture and sensitivity revealed moderate growth of Staphylococcus-aureus. Patient was started on appropriate intravenous antibiotics. Magnetic resonance imaging (MRI) done after 2 weeks revealed marked erosion in the lateral end of clavicle with soft tissue collection along the posteromedial aspect A-C joint. The patient had to undergo repeat drainage of the abscess along with the decompression of lateral end of clavicle. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection.
Collapse
|
3
|
Zaremski JL, McQuerry JL. Septic Acromioclavicular Joint Due to Throwing in an Adolescent Football Player: A Case Report. Curr Sports Med Rep 2022; 21:146-148. [PMID: 35522437 DOI: 10.1249/jsr.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jason L Zaremski
- Department of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery and Sports Medicine, University of Florida Health UF Health Orthopaedics and Sports Medicine Institute, Gainesville, FL
| | | |
Collapse
|
4
|
Gaffaney L, McKee-Proctor M, Yeung HM. Lumbar osteomyelitis and knee septic arthritis caused by Streptococcus agalactiae bacteraemia. BMJ Case Rep 2022; 15:e249337. [PMID: 35440435 PMCID: PMC9020308 DOI: 10.1136/bcr-2022-249337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his late 70s presented to the emergency department endorsing a week of malaise. He was recently hospitalised for 2 days for new back pain and was discharged with non-opioid pain medications but continued to seek care as he felt unwell. On presentation, he was afebrile with a leukocytosis. Physical examination revealed a painful left knee with no evidence of trauma. Arthrocentesis revealed purulent fluid with elevated white blood cell consistent with septic arthritis. He was started on broad-spectrum antibiotics and underwent irrigation and synovectomy of the left knee. Aspirate and blood cultures grew Streptococcus agalactiae Transthoracic echocardiogram showed no vegetations; however, an MRI of lumbar spine showed L2-L3 and L4-L5 osteomyelitis. He was treated with intravenous ceftriaxone for 3 weeks and then oral levofloxacin for 3 weeks, for a total 6 week course of antibiotics.
Collapse
Affiliation(s)
- Lauren Gaffaney
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Maxwell McKee-Proctor
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ho-Man Yeung
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Yeh HT, Liau SK, Niu KY, Hsiao CH, Yeh CC, Lu JX, Ng CJ, Yen CC. Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030401. [PMID: 35334577 PMCID: PMC8953317 DOI: 10.3390/medicina58030401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Septic arthritis is a medical emergency associated with high morbidity and mortality. The incidence rate of septic arthritis among dialysis patients is higher than the general population, and dialysis patients with bacteremia frequently experience adverse outcomes. The aim of this study was to identify the clinical features and risk factors for longer hospital length of stay (LOS), positive blood culture, and in-hospital mortality in dialysis patients with septic arthritis. Materials and Methods: The medical records of 52 septic arthritis dialysis patients admitted to our hospital from 1 January 2009 to 31 December 2020 were analyzed. The primary outcomes were bacteremia and in-hospital mortality. Variables were compared, and risk factors were evaluated using linear and logistic regression models. Results: Twelve (23.1%) patients had positive blood cultures. A tunneled cuffed catheter for dialysis access was used in eight (15.4%) patients, and its usage rate was significantly higher in patients with positive blood culture than in those with negative blood culture (41.7 vs. 7.5%, p = 0.011). Fever was present in 15 (28.8%) patients, and was significantly more frequent in patients with positive blood culture (58.3 vs. 20%, p = 0.025). The most frequently involved site was the hip (n = 21, 40.4%). The most common causative pathogen was Gram-positive cocci, with MRSA (n = 7, 58.3%) being dominant. The mean LOS was 29.9 ± 25.1 days. The tunneled cuffed catheter was a significant predictor of longer LOS (Coef = 0.49; Cl 0.25−0.74; p < 0.001). The predictors of positive blood culture were fever (OR = 4.91; Cl 1.10−21.83; p = 0.037) and tunneled cuffed catheter (OR = 7.60; Cl 1.31−44.02; p = 0.024). The predictor of mortality was tunneled cuffed catheter (OR = 14.33; Cl 1.12−183.18; p = 0.041). Conclusions: In the dialysis population, patients with tunneled cuffed catheter for dialysis access had a significantly longer hospital LOS. Tunneled cuffed catheter and fever were independent predictors of positive blood culture, and tunneled cuffed catheter was the predictor of in-hospital mortality. The recognition of the associated factors allows for risk stratification and determination of the optimal treatment plan in dialysis patients with septic arthritis.
Collapse
Affiliation(s)
- Hsin-Tzu Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Shuh-Kuan Liau
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan;
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan; (K.-Y.N.); (C.-C.Y.)
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN 47405, USA;
| | - Chung-Cheng Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan; (K.-Y.N.); (C.-C.Y.)
| | - Jian-Xun Lu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-033281200
| |
Collapse
|
6
|
Chan JC, Baker JF. Septic Arthritis of the Acromioclavicular Joint: A Single-Center, 11-Year Retrospective Review. Orthopedics 2021; 44:e493-e497. [PMID: 34292831 DOI: 10.3928/01477447-20210618-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Septic arthritis of the smaller acromioclavicular joint is uncommon, with only a few reports and case series available in the literature. The aim of this outcomes analysis was to determine the prevalence of shoulder girdle septic arthritis within the authors' institution, with a particular focus on describing the authors' experience with acromioclavicular joint septic arthritis. A retrospective outcomes analysis was conducted of patients admitted to a single tertiary referral center from 2008 to 2018 with acromioclavicular joint septic arthritis. Demographic and clinical data were recorded for each patient; the modified Frailty Index score was calculated for each patient. Nine patients were identified as having acromioclavicular joint septic arthritis, making up 12% of shoulder girdle septic arthritis. Diabetes mellitus was the most prevalent comorbidity, present in 4 (44.4%) patients. Staphylococcus aureus was responsible in 55.6% and Streptococcus species in 44.4%. Seven patients were treated surgically. Mean (SD) length of antibiotic therapy was 6.2 (2.7) weeks. Mean (SD) length of stay was 6 (2.83) days (range, 4-8 days) for patients who received antibiotic therapy only and 12.7 (7.52) days for those who proceeded for operative management. Mean modified Frailty Index score was 1.1. Septic arthritis of the acromioclavicular joint is an uncommon infection that occurs both in patients with impaired immunity and in those with intact immune systems. Tailored antimicrobial therapy in conjunction with surgical intervention, when indicated, appears to result in successful suppression or eradication of infection in the majority of cases. [Orthopedics. 2021;44(4):e493-e497.].
Collapse
|
7
|
Pérez-López LM, Subirá-Álvarez T, Martínez-Ruíz A, Noguera-Julian A, Moreno-Romo D, Torner-Rubies F, Galo Fontecha C. Non-axial osteoarticular tuberculosis in the paediatric age. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
8
|
Pérez-López LM, Subirá-Álvarez T, Martínez-Ruíz A, Noguera-Julian A, Moreno-Romo D, Torner-Rubies F, Fontecha CG. Non-axial osteoarticular tuberculosis in the paediatric age. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:186-194. [PMID: 33495138 DOI: 10.1016/j.recot.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Osteoarticular tuberculosis, caused by a member of the Mycobacterium genus, represents approximately 10% of the total extrapulmonary tuberculosis in pediatric patients. Its low prevalence and nonspecific clinical presentation lead to a late diagnosis and elevated risk of sequelae. PATIENTS AND METHODS This retrospective study included seven pediatric patients with non-vertebral osteoarticular tuberculosis diagnosed between 2006 and 2019. The patients were classified in accordance with the radiographic criteria of Kerri and Martini. RESULTS The mean patient age was 7,4 years (median, 5 years; range, 2-16 years). The mean follow-up time was 18,5 months (range, 10-32 months). The mean diagnostic delay was 4,7 months (range, 1-8 months). The locations were femoral head osteoarthritis (two patients) and proximal humerus osteomyelitis, talus dome osteoarthritis, distal clavicle osteoarthritis, proximal ulna epiphysis osteoarthritis, and tibiotalar arthritis along with subtalar gland (one patient each). The clinical findings were lameness (four patients), localized pain (two patients), functional impotence, constitutional syndrome (asthenia, anorexia, and involuntary loss of>5% of total body weight) (two patients), local inflammatory signs (one patient), and fever (one patient). One patient was asymptomatic and received a diagnosis during pulmonary radiological analysis. Medical treatment with four drugs was performed in all patients; five patients required surgical treatment for abscess drainage, three of them open drainage, and two with laparoscopic drainage. CONCLUSIONS The final results were satisfactory, such that 71% of patients recovered joint balance but with radiological sequelae in 57,1% patients. Good prognosis, according to our results, depends on younger age and early diagnosis with early medical or surgical treatments.
Collapse
Affiliation(s)
| | - Teresa Subirá-Álvarez
- Servicio de Cirugía Ortopédica y Traumatología, Consorci de Terrassa, Barcelona, España
| | - Amalia Martínez-Ruíz
- Servicio de Cirugía Ortopédica y Traumatología, Consorci de Terrassa, Barcelona, España
| | - Antoni Noguera-Julian
- Enfermedades Infecciosas y Respuesta Inflamatoria Sistémica en Pediatría, Unidad de Infecciones, Instituto de Investigación Pediátrica Hospital Sant Joan de Déu, Barcelona, España; Departamento de Pediatría, Universidad de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, España; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, España
| | - David Moreno-Romo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sant Joan de Déu, Barcelona, España
| | - Ferran Torner-Rubies
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sant Joan de Déu, Barcelona, España
| | - César Galo Fontecha
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sant Joan de Déu, Barcelona, España
| |
Collapse
|
9
|
Steinmetz RG, Maupin JJ, Smith JN, White CB. Septic arthritis of the acromioclavicular joint: a case series and review of the literature. Shoulder Elbow 2020; 12:272-283. [PMID: 32788932 PMCID: PMC7400718 DOI: 10.1177/1758573218815289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/28/2018] [Accepted: 10/30/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report a case series of three patients with septic arthritis of the acromioclavicular joint and a review of the literature for this condition. Additionally, we developed an algorithm for diagnosing and treating septic arthritis of the acromioclavicular joint. METHODS A retrospective review of patients treated at our institution for septic arthritis of the acromioclavicular joint during the collection period was performed and three cases were identified. A review of the English literature on this rare condition was also performed with only 28 cases being identified. RESULTS A series of three consecutive patients were treated for septic acromioclavicular arthritis with resolution of the infection. Two patients underwent open surgical debridement and one underwent aspiration. All patients were treated with a minimum of six weeks of tailored intravenous antibiotic therapy. CONCLUSION Septic arthritis of the acromioclavicular joint can be difficult to diagnose and requires a high index of suspicion. Surgical debridement, open or arthroscopic, with tailored antibiotic therapy is an effective means for the management of septic arthritis of the acromioclavicular joint. In patients who are unable to have surgical debridement, aspiration and tailored antibiotics have been shown to be effective.
Collapse
Affiliation(s)
- Raymond G Steinmetz
- Garrett Steinmetz, 800 Stanton L Young Blvd, AAT-3400 Oklahoma City, OK 73104, USA.
| | | | | | | |
Collapse
|
10
|
Acromioclavicular Septic Arthritis Caused by Veillonella parvula. Case Rep Orthop 2019; 2019:7106252. [PMID: 31885984 PMCID: PMC6900941 DOI: 10.1155/2019/7106252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
We hereby report the case of a primary acromioclavicular septic arthritis caused by Veillonella parvula. This bacteria is rare as a pathogen but is well known as a commensal of the lungs, vagina, mouth, and gastrointestinal tract of humans. However, it may turn as an opportunistic pathogen. It was isolated in blood culture and confirmed in biopsy specimen. The patient had complete recovery after surgical washout with second look at postoperative day two and targeted antibiotic treatment.
Collapse
|
11
|
Septic arthritis of the acromioclavicular joint due to Streptococcus agalactiae. Case report. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2016.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
12
|
Dutt S, Lodhi J, Kumar V, Kashyap A. Acromioclavicular joint septic arthritis in an immunocompetent child: A case report. Chin J Traumatol 2018; 21:182-185. [PMID: 29773450 PMCID: PMC6033726 DOI: 10.1016/j.cjtee.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/12/2017] [Accepted: 12/10/2017] [Indexed: 02/04/2023] Open
Abstract
Septic arthritis of acromioclavicular (AC) joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients. We report a case of septic arthritis of AC joint in an immunocompetent child. A 9 years old girl presented with history of pain in left shoulder for 4 days associated with fever. No history suggestive of any immunocompromised state was complained. On local examination, a swelling of around 3 cm in diameter was found over left AC joint region with raised local temperature, tenderness on palpation and positive response in fluctuation test. Total leukocyte count was 18.7 × 109/L with 80% of neutrophils. Erythrocyte sedimentation rate (ESR) was 28 mm/1 h. C-reactive protein (CRP) was 12 mg/L. X-ray showed enlarged left AC joint space. Ultrasound revealed hypoechoic collection in the AC joint and the surrounding area. The aspirate was thick and purulent in nature, revealing Gram positive cocci at staining. Arthrotomy and thorough lavage of AC joint was done. Culture of the aspirate showed Methicillin Resistant Staphylococcus Aureus (MRSA) after 48 hours that was sensitive to amikacin, gentamicin, erythromycin and teicoplanin. Patient was symptom-free at 2 months of follow-up with no signs of osteomyelitis on the radiographs. Thus this is the first case of AC joint septic arthritis in healthy individual. Being proximal to the shoulder joint, AC joint septic arthritis can be confused with the shoulder joint septic arthritis. Thus, high index of suspicion is required for accurate diagnosis.
Collapse
|
13
|
Bilateral and simultaneous septic arthritis of the acromioclavicular joint in an immunocompromised patient: a case report and review of the literature. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
14
|
Williams M. Diagnostic challenges in acromioclavicular septic arthritis. BMJ Case Rep 2016; 2016:bcr-2016-216034. [PMID: 27257000 DOI: 10.1136/bcr-2016-216034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 69-year-old man with Klinefelter's syndrome presented with a painful shoulder and staphylococcal sepsis. He received intravenous antibiotics while investigations were performed to locate the source of infection. MRI demonstrated infection in the acromioclavicular joint (ACJ). The patient clinically improved and a further 5 weeks of oral antibiotics were given. He remained asymptomatic at 2-year follow-up. Although ACJ septic arthritis is rare, independent of immune-competent status, a high index of suspicion is essential for prompt diagnosis. The condition presents additional diagnostic challenges due to unfamiliarity, the challenges of interpreting imaging, desire for radiological guided arthrocentesis and low volume aspirates. Overcoming these pitfalls is essential to avoid significant morbidity and mortality.
Collapse
|
15
|
Dupley L, Berg AJ, Mohil R. Secondary infection of haematoma following closed acromioclavicular joint dislocation. BMJ Case Rep 2016; 2016:bcr-2015-211090. [PMID: 26786526 DOI: 10.1136/bcr-2015-211090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
An unusual case of a patient presenting with a large infected haematoma following a traumatic grade II acromioclavicular joint dislocation is reported. Diagnosis of this rare complication, of an otherwise common self-limiting injury, was delayed until 19 days postinjury despite several presentations during this time with worsening swelling and pain. The patient was found to have significant tissue destruction by the time washout was performed and required multiple procedures to treat the infection. This case highlights the need for a high index of suspicion for complications, even following common self-limiting injuries, when patients represent with symptoms that do not fit the usual natural history of the condition, particularly if they have risk factors for bleeding and infection.
Collapse
|
16
|
Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis. Case Rep Infect Dis 2014; 2014:313056. [PMID: 24987538 PMCID: PMC4058585 DOI: 10.1155/2014/313056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/15/2014] [Indexed: 12/11/2022] Open
Abstract
Infective endocarditis (IE) is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC) joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic.
Collapse
|
17
|
Hong MJ, Kim YD, Ham HD. Acute septic arthritis of the acromioclavicular joint caused by Haemophilus parainfluenzae: a rare causative origin. Clin Rheumatol 2014; 34:811-4. [DOI: 10.1007/s10067-014-2554-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/23/2014] [Indexed: 12/28/2022]
|
18
|
Artritis séptica de la articulación acromioclavicular: una localización atípica. ACTA ACUST UNITED AC 2014; 10:37-42. [DOI: 10.1016/j.reuma.2013.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 06/02/2013] [Accepted: 06/19/2013] [Indexed: 11/18/2022]
|
19
|
Martínez-Morillo M, Mateo Soria L, Riveros Frutos A, Tejera Segura B, Holgado Pérez S, Olivé Marqués A. Septic Arthritis of the Acromioclavicular Joint: An Uncommon Location. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.reumae.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
20
|
Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BR. Degenerative joint disease of the acromioclavicular joint: a review. Am J Sports Med 2013; 41:2684-92. [PMID: 23649008 DOI: 10.1177/0363546513485359] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Osteoarthritis of the acromioclavicular (AC) joint is a common condition causing anterior or superior shoulder pain, especially with overhead and cross-body activities. This most commonly occurs in middle-aged individuals because of degeneration to the fibrocartilaginous disk that cushions the articulations. Diagnosis relies on history, physical examination, imaging, and diagnostic local anesthetic injection. Diagnosis can be challenging given the lack of specificity with positive physical examination findings and the variable nature of AC joint pain. Of note, symptomatic AC osteoarthritis must be differentiated from instability and subtle instability, which may have similar symptoms. Although plain radiographs can reveal degeneration, diagnosis cannot be based on this alone because similar radiographic findings can be seen in asymptomatic individuals. Nonoperative therapy can provide symptomatic relief, whereas patients with persistent symptoms can be considered for resection arthroplasty by open or arthroscopic technique. Both techniques have proven to provide predictable pain relief; however, each has its own unique set of potential complications that may be minimized with an improved understanding of the anatomical and biomechanical characteristics of the joint along with meticulous surgical technique.
Collapse
Affiliation(s)
- Nathan A Mall
- Brian J. Cole, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison, Suite 300, Chicago, IL 60612.
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Iyengar KP, Gudena R, Chitgopkar SD, Ralte P, Hughes P, Nadkarni JB, Loh WYC. Primary septic arthritis of the acromio-clavicular joint: case report and review of literature. Arch Orthop Trauma Surg 2009; 129:83-6. [PMID: 18810473 DOI: 10.1007/s00402-008-0747-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Indexed: 11/24/2022]
Abstract
Primary septic arthritis of the Acromio clavicular joint is an uncommon disorder and is rarely seen even in an immunocompromised individual. We report a case of primary septic arthritis of the acromio-clavicular (A-C) joint caused by Staphylococcus aureus without any predisposing factors. The patient was admitted with left shoulder pain, restricted movements and fever. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Blood cultures were positive for Staphylococcus-aureus. Magnetic resonance imaging (MRI) using Gadolinium enhancement revealed marked effusion in the A-C joint. Aspiration from the A-C joint revealed a heavy growth of Staphylococcus-aureus. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection and return to full function.
Collapse
Affiliation(s)
- Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Town Lane, Kew, Southport, PR8 6PN, UK
| | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Fayad LM, Carrino JA, Fishman EK. Musculoskeletal infection: role of CT in the emergency department. Radiographics 2008; 27:1723-36. [PMID: 18025514 DOI: 10.1148/rg.276075033] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Musculoskeletal infection is commonly encountered in the emergency department and can take many forms, depending on the involvement of the various soft-tissue layers, bones, and joints. Infection may manifest as superficial cellulitis, necrotizing or nonnecrotizing fasciitis, myositis, a soft-tissue abscess, osteomyelitis, or septic arthritis. Because clinical parameters for the detection of musculoskeletal infection generally lack sensitivity and specificity, computed tomography (CT) plays an important role in the assessment of potential musculoskeletal infections in the emergency department. CT provides an analysis of compartmental anatomy, thereby helping to distinguish among the various types of musculoskeletal infection and to guide treatment options. Specific imaging features exist that help identify the numerous forms of infection in the bones and soft tissues, and CT is invaluable for detecting deep complications of cellulitis and pinpointing the anatomic compartment that is involved by an infection. Although all patients with musculoskeletal infection will require treatment with antibiotics, CT helps guide therapy toward emergency surgical débridement in cases of necrotizing fasciitis and toward percutaneous drainage in cases of abscess formation.
Collapse
Affiliation(s)
- Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Wolfe St, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|