What Is Shoulder Arthritis
Shoulder arthritis is damage to the cartilage inside the shoulder joint. The shoulder has two joints. Shoulder arthritis commonly refers to the bigger ball-and-socket joint named the glenohumeral joint after the bones it connects . The cartilage covers both the ball and the socket .
When the cartilage in the shoulder begins to break down on the surface and eventually in the deeper layers, its called shoulder arthritis. The second joint in the shoulder, the acromioclavicular or AC joint, can also develop arthritis known as AC joint arthritis.
How Is Septic Arthritis Diagnosed In A Child
Early diagnosis of septic arthritis is important. This is to prevent long-term damage to the joint. Your childs healthcare provider will take your childs health history and give him or her a physical exam. Tests may also be done, such as:
- Removal of joint fluid. This is done to check for white blood cells and bacteria.
- Blood tests. These are done to look for bacteria.
- Phlegm, spinal fluid, and urine tests. These are done to look for bacteria and find the source of infection.
- X-ray. This test uses a small amount of radiation to make images of internal tissues, bones, and organs.
- Bone scan. This imaging test uses a tiny amount of a radioactive substance to look for arthritis changes in the joints.
- MRI. This test uses large magnets and a computer to make detailed images of organs and other tissues.
- Radionuclide scans. These scans use a tiny amount of a radioactive substance to look at organs and the blood flow to them.
Joint Colonization And Bacterial Adherence
The synovial membrane has no limiting basement plate under the well-vascularized synovium this allows easy hematogenous entry of bacteria. As mentioned above, bacteria may also gain entry into the joint by direct introduction or extension from a contiguous site of infection. Once bacteria are seeded within the closed joint space, the low fluid shear conditions enable bacterial adherence and infection. Colonization may also be aided in cases where the joint has undergone recent injury. In this environment, the production of host-derived extracellular matrix proteins that aid in joint healing may promote bacterial attachment and progression to infection. The virulence and tropism of the microorganisms, combined with the resistance or susceptibility of the synovium to microbial invasion, are major determinants of joint infection. S. aureus, Streptococcus spp., and N. gonorrhoeae are examples of bacteria that have a high degree of selectivity for the synovium, probably related to adherence characteristics and toxin production. Aerobic gram-negative bacilli such as Escherichia coli rarely infect the synovium except in the presence of an underlying and compromising condition. The virulence of the organism once inside the joint varies. In rabbits, intra-articular injection of 10 5S. aureus organisms into the knee joint resulted in major joint destruction but identical injections of N. gonorrhoeae or S. epidermidis caused no joint inflammation .
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Determining Physical And Behavioral Symptoms
Multiple Etiologies In The Pediatric Age Group
Staphylococcus aureus is the most common bacterial pathogen overall. The hip joint is most commonly affected in children.
Some etiologic agents are associated with specific age groups and underlying medical conditions.
- Kingella kingae is the most common gram-negative bacterial cause in children younger than 2 to 3 years.
- Group B Streptococcus, Staphylococcus aureus, Neisseria gonorrhea, and gram-negative Bacilli are common among neonates.
- Neisseria gonorrhea is a concern in sexually active adolescents.
- Salmonella species infection is associated with sickle cell disease.
- Patients on prolonged antibiotic therapy are at risk for fungal infections.
- Puncture wounds and injection drug use are associated with joint infection due to Pseudomonas aeruginosa.
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How Do You Treat Arthritis In Horses
- Early and aggressive treatment is required. If possible arthroscopic examination of the joint should be performed.
- This enables a thorough examination and removal of any fibrin clots and other debris. Most importantly, it allows extensive lavage of the joint.
- If arthroscopy cannot be performed, lavage via a 10-14 gauge catheter should be performed.
- An ingress and egress catheter should be placed on either side of the joint, and 10-15 L balanced polyionic solution flushed through. Saline should be avoided, as this can be irritant to articular cartilage and synovial membrane.
- During flushing, the egress cannula should be frequently closed to allow distension irrigation of the joint.
- The use of intra-articular medication is controversial. The main objection has been that the drugs used will create synovitis and thus harm articular cartilage.
- However, in view of the severity of the disease process induced by the sepsis, the additional synovitis is probably minimal.
How Is Septic Arthritis Diagnosed
A procedure called arthrocentesis is commonly used to make an accurate diagnosis of septic arthritis. This procedure involves a surgical puncture of the joint to draw a sample of the joint fluid, known as synovial fluid. Normally, this fluid is sterile and acts as a lubricant.
During arthrocentesis, a needle is inserted into the affected joint to collect fluid from the joint. The fluid sample is sent to a lab for evaluation. The lab will perform a white cell count on the fluid, which will usually very high. The lab will also try to culture bacteria or other organisms. This will help the doctor determine if an infection is present and which organism is causing it.
X-rays are typically done to look for joint damage. Blood tests can also be used to monitor inflammation. MRI scanning is sensitive in evaluating joint destruction but is less useful in the early stages . Blood tests can also be taken to detect and monitor inflammation.
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Management Of Septic Arthritis
Antibiotic treatment for septic arthritis
Prompt treatment with antibiotics together with removal of any purulent material is the mainstay of treatment for septic arthritis. There is little evidence on which to base the choice and duration of antibiotic treatment, and we found no randomised, controlled trials. One systematic review and metaanalysis of antibiotic treatment for joint infections showed no advantage in clinical or bacteriological efficacy of one antibiotic regimen over another. Currently, the choice of antibiotic is based on the likelihood of the organism involved, modified by the results of Gram staining and culture. A summary of suggested empirical antibiotic treatment is presented in table 4.
Table 4Suggested empirical antibiotic treatment of suspected septic arthritis
ITU, intensive therapy unit IV, intravenous MRSA, methicillinresistant Staphylococcus aureus qds, four times in a day UTI, urinary tract infection tds, thrice a day.
Antibiotic choice will need to be modified in the light of results of Gram stain and culture. It should also be reviewed locally by microbiology departments.
Synovial Fluid Pcr For B Burgdorferi
Although reported in a few patients, it is exceedingly difficult to culture B. burgdorferi from synovial fluid in patients with Lyme arthritis. This is presumably due to the fact that joint fluid, with its many inflammatory mediators, is an extremely hostile environment. In spiked cultures, adding small amounts of joint fluid results in rapid killing of spirochetes. In contrast, polymerase chain reaction testing of synovial fluid for B. burgdorferi DNA often yields positive results before antibiotic therapy ,, and usually becomes negative following antibiotic treatment. However, spirochetal DNA may persist after spirochetal killing, which limits its use as a test for active infection. Moreover, PCR testing has not been standardized for routine clinical use. Therefore, in most cases, the appropriate clinical picture and a positive serologic result are sufficient for diagnosis of Lyme arthritis, and PCR testing serves as an optional test to further support the diagnosis.
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Amps And Septic Arthritis
Although the research targeting use of AMPs against bacterial arthritis is scarce, we present few important findings. Varoga et al . reported enhanced expression of human -defensin-2 in synovial membranes that were exposed to bacteria mimicking a case of septic arthritis. The study showed that bacteria-colonized synovial membranes displayed comparatively higher levels of human -defensin-2 peptide than unexposed samples. This suggests the involvement of these cationic peptides in intra-articular defense mechanisms and their role in regulating the pathological course of septic arthritis.
Studies also highlighted the protective role of AMPs as part of innate system of the articular cartilage against infection and emphasized that purified or recombinant AMPs represent potential therapeutic agents that can be administered in septic arthritis to further boost the innate resistance system of the synovial tissue .
Table 1 New Developments related to AMP research against Bone and Joint Infections
How Do You Develop Septic Arthritis
If some germs settle on a small section of a joint, they can multiply and cause infection. Bacteria can get to a joint:
- Via the bloodstream. This is the most common cause, particularly in children. Bacteria may get into the blood from an infection in another part of the body and travel to a bone. Even if you are healthy, bacteria from the nose or gut sometimes get into the blood.
- From an injury. Bacteria can get into a joint if you have a wound that cuts into a joint.
- During surgery. Infection is an uncommon complication if you have joint surgery or joint investigations .
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What You Need To Know
- Arthritis is damage to the cartilage in joints. Shoulder arthritis occurs when the cartilage starts wearing down on the ball and/or socket sides of the shoulder joint.
- Symptoms of shoulder arthritis may include pain in the shoulder joint, stiffness and reduced range of motion.
- There are many nonoperative treatments for shoulder arthritis, including stretches, lifestyle modifications, application of ice or heat, and medication to control the pain.
- Surgical options, such as shoulder replacement, are available to treat shoulder arthritis if nonoperative treatments dont offer the desired relief.
What Is Septic Arthritis In Dogs
In a dog with osteoarthritic joints, the joint damage is of inflammatory nature. In a dog with infected joints, the joint damage is caused by infection followed by inflammatory changes, joint effusion, joint swelling, pain, and lameness.
While regular arthritis is usually associated with old age and has a gradual onset, septic arthritis can occur in any dog suddenly and with more severe clinical signs.
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Which Organisms Cause Septic Arthritis And What Are The Risk Factors
All the major surveys of septic arthritis demonstrate that the predominant causative organisms of septic arthritis are either staphylococci or streptococci.,,,,,,, These organisms account for 91% of cases.
Gram negative organisms are more common in older patients and in those immunocompromised than in young adults. Anaerobic organisms rarely cause septic arthritis, but are more common when there is a history of penetrating trauma.
Risk factors for the development of joint sepsis include:
-
cutaneous ulcers.
A prospective community survey of bacterial arthritis found that a number of factors seem to be associated with a poor prognosis. These include older age, preexisting joint disease and the presence of synthetic material within the joint.
How Is Septic Arthritis Treated In A Child
Treatment will depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is.
Pus may be drained from the joint. Pus buildup can damage the joint. The pus is drained with a needle, tube, or surgery. Other treatment may include:
- Medicines for pain and fever
- Physical therapy to keep muscle strength
- A splint on the joint to ease pain
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Bacterial Products And Their Pathogenic Role
While bacterial attachment proteins promote colonization and initiate the infectious process, a number of bacterial products activate the host immune response and increase tissue damage in cases of septic arthritis. S. aureus has a large variety of factors that have been implicated in host virulence. Many of these factors have been tested for their ability to increase the morbidity and mortality associated with acute septic arthritis. Most studies evaluating the potential role of these bacterial products have been performed using the murine model of septic arthritis .
During acute septic arthritis, the innate immune system responds to the presence of the peptidoglycan wall of S. aureus to produce proinflammatory cytokines and C-reactive protein. Bacterial DNA also elicits an intense inflammatory response . When bacterial DNA from S. aureus or E. coli or synthetic, unmethylated oligonucleotides containing CpG motifs were injected into the knee joint of mice, arthritis developed quickly and lasted up to 14 days, while methylated DNA had no significant effect. Also, the affected tissue was characterized by monocyte and macrophage influx with the release of their associated cytokines and chemokines and the absence of T cells.
Tests To Confirm The Diagnosis
If you have typical symptoms coming from a joint near to the skin surface then the diagnosis may be fairly clear. However, pain coming from deeper joints such as the hip may be due to a number of causes. Certain blood tests can help to confirm that you have severe inflammation ‘somewhere’ in the body, which may be septic arthritis.
A plain X-ray is not so useful to diagnose the early stages of septic arthritis. However, it may be a useful test to rule out other causes of joint pain. An ultrasound scan, CT scan or MRI scan of the joint may help to confirm the diagnosis.
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How Does A Doctor Know My Child Has Septic Arthritis
Prompt diagnosis of septic arthritis is necessary to prevent permanent damage to the joint.
In addition to a complete medical history and physical examination, diagnostic procedures for septic arthritis may include:
- removal of joint fluid: to examine for white blood cells and bacteria
- blood tests: to detect bacteria
- phlegm, spinal fluid, and urine tests: to detect bacteria and find the source of infection
- x-ray: a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
- bone scan: a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints to detect bone diseases and tumors to determine the cause of bone pain or inflammation
- magnetic resonance imaging : a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
- radionuclide scans: nuclear scans of various organs to determine blood flow to the organs
How To Diagnose Septic Arthritis
This article was co-authored by Siddharth Tambar, MD. Dr. Siddharth Tambar, MD is a board certified rheumatologist at Chicago Arthritis and Regenerative Medicine in Chicago, Illinois. With over 19 years of experience, Dr. Tambar specializes in Regenerative Medicine and Rheumatology, with a focus on Platelet rich plasma and Bone marrow derived stem cell treatments for arthritis, tendinitis, injuries, and back pain. Dr. Tambar holds a BA in Economics from State University of New York at Buffalo. He earned his MD from State University of New York at Syracuse. He completed his Internship, Residency in Internal Medicine, and his Rheumatology Fellowship at Northwestern Memorial Hospital. Dr Tambar is board certified in both rheumatology and internal medicine. He also holds Musculoskeletal Ultrasound Diagnostic and Interventional certifications from the American College of Rheumatology and the American Institute of Ultrasound in Medicine.There are 9 references cited in this article, which can be found at the bottom of the page. This article has been viewed 22,865 times.
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What Causes Septic Arthritis
Septic arthritis usually is caused by bacteria that spread through the blood stream from another area of the body. It can also be caused by a bacterial infection from an open wound or an opening from a surgical procedure, such as knee surgery.
In adults and children, common bacteria that cause acute septic arthritis include staphylococcus and streptococcus. Among young, sexually active adults, neisseria gonorrhoeae is the most common pathogen for the condition. These foreign invaders enter the bloodstream and infect the joint, causing inflammation and pain.
Other infections, such as those caused by viruses and fungi, can also cause arthritis. Viruses include:
- Hepatitis A, B, and C
- Parvovirus B19
- Flaviviruses
Fungi that can cause arthritis include histoplasma, coccidiomyces, and blastomyces. These infections are usually slower to develop than bacterial infections.
Is The Infected Fluid Drained
Drainage of the infected area is critical for rapid clearing of the infection. Drainage is performed by removing the fluid with a needle and syringe. Often the draining occurs daily or with multiple surgical procedures. The exact method depends on the location of the joint.
Using arthroscopy, your doctor can irrigate the joint and remove the infected tissue. If drainage cannot be accomplished with joint aspirations or arthroscopy, open joint surgery is often necessary to drain the joint. If the fluid buildup is significant, the drains are left in place to remove excess fluid that may build up after the surgery.
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