Daily Bolus of LR: Septic arthritis of the sterno-clavicular joint

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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.

 

Exam:

·         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

 

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