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

Leave a comment

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


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: