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Topic Confernce: Int Nontapat Paesaroch
Topic Confernce: Int Nontapat Paesaroch
- Rheumatoid arthritis
- Immunosuppressive drug therapy
- Chronic disorder
- AIDS
- Intravenous drug abuse
- Alcoholism
Pathogenesis
ㆍ Bacteria can gain entrance to a joint via 3
routes:
Direct Inoculation
May result from penetrating trauma
Introduction of organisms during diagnostic and surgical procedures. For eg arthroscopy and intra-articular
injection
Healing with:
1.Complete resolution
2.Partial loss of articular cartilage and fibrosis of joint
3.Loss of articular cartilage and bony ankylosis
4.Bony destruction and permanent deformity
Clinical Features
Differ according to age
In new born infants In children In adults
- More on septicaemia - acute pain in single large joint - Often in the superficial joint
Rather than joint pain (esp hip) (knee, wrist or ankle )
- Baby is irritable & refuse -Pseudoparesis - Joints painful, swollen &
to feed - Child is ill, rapid pulse inflamed.
- Tachycardia with fever and swingingfever - Warmth and marked local
- Joints are warmth, - Overlying skin looks red tenderness & movement
tenderness, resistance to & superficial joint swelling restricted.
movement may be obvious - look for gonococcal infection
- Umbilical cord and - Local warmth and or drug abuse.
inflamed IV site should be marked tenderness - Patient with rheumatoid
suspicious of source of - All movements are restricted by arthritis and especially those
Infection pain or spasm. on corticosteroid may develop
- Look for source of infection
from septic toe or discharge ear
Physical examination:
- Lower limb → antalgic limp / cannot walk
- Upper limb → affected part is closedly guarded
- Marked tenderness, active and passive range of motion are limited
- Examine for synovial effusion, erythema, heat and tenderness.
- Spasm of muscles around the joint may be marked.
- Patient may hold the joint in a position to reduce the intra-articular pressure to minimize
pain.
Investigations
Investigations Explaination
X ray
o Early Stage – Normal
o Look for soft tissue swelling, loss of tissue planes, widening of joint
space and slight subluxation due to fluid in joint. Gas may be seen with
E. coli infection
o Late stage - Narrowing and irregularity of joint space
o Plain film findings of superimposed osteomyelitis may develop
(periosteal reaction, bone destruction, sequestrum formation).
Ultrasonography
- Surgical Drainage
- Arthroscopic debridement and copious irrigation with normal
saline - more frequently in knee joint septic arthritis
Complications
• Bone destruction and dislocation of the
joint (esp !Hip)
• Cartilage destruction
- may lead to either fibrosis or bony
ankylosis
- in adult partial destruction of the joint will
result in secondary osteoarthritis
• Growth disturbance
- presenting as either localised deformity or
shortening of the bone