April 7, 2011 by dailybolusoflr
Septic arthritis of the sterno-clavicular joint
This uncommon location for septic arthritis is an important diagnosis to consider in patients with pain, swelling and tenderness focally located over the sterno-clavicular joint.
It accounts for less than 1% of septic arthritis diagnoses by location. However, of all patients with sterno-clavicular joint septic arthritis, close to 20% are in intravenous drug abusing patients.
· Patients most often complain of pain directly over the joint, however in the last patient I diagnosed with this (and confirmed by the literature) that patient was complaining of chest and shoulder pain.
· The location is often focally tender, and can be red, swollen and hot.
· Physical findings on exam are not always noted, however.
· Confirmatory test of choice for the ED is a CT scan, which can find inflammatory changes, effusion of the joint or local spread with abscess, phlegmon or mediastinitis.
· Over half of the patients are bacteremic on presentation.
· The most common organism is staph aureus and coverage for MRSA should be started.
· Patients should be admitted when the diagnosis is confirmed.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions