Clinical Pearl Wednesday #25

Worried about a septic joint? Follow these steps!

If someone has a swollen, erythematous, warm and painful joint, percuss the joint distal to it (distal percussion test).

For example, if you suspect a septic elbow, have the patient extend their arm, hyperextend the hand, and vigorously tap the hand. Same with the knee, have the patient extend the leg and forcefully tap the bottom of their foot.

If the joint is septic, this will elicit significant pain. If there is no pain, then the chances of the joint being septic are very low.

Have the patient perform full ROM movements of the joint in question. If there is pain out of proportion, then a septic joint is possible. If it is painless, then the chances are very low.

Also, inquire about an injury. It is practically impossible for a joint to become septic without the introduction of a foreign pathogen by a penetrating injury/mechanism.

No penetrating injury + negative pain on percussion + painless ROM = extremely low risk of a septic joint.

If the patient meets these criteria, I will forgo tapping the joint for laboratory analysis and treat it as an inflammatory etiology with NSAIDs and possibly steroids. It has never failed me.

2 Responses

  1. I recently got in touch with a girlfriend who told me she has been complaining of major knee pain to her MD for 3 months. Fast forward almost 12 months later after she has been tested for all kinds of autoimmune diseases she started having problems with her vision and was finally diagnosed by another provider to have Uveitis and got appropriately tested and found out she had Chlamydia compliments of her cheating (now)ex-boyfriend. I remember learning about this but the percentage of population who can develop these symptoms is low right? In your experience have you seen this, or gonoccocal arthritis before? I am a new NP and trying to learn as much as I can. Thank you for all your posts, they are very helpful.

    1. Yes its pretty low. I have only seen it a handful of times. I have never seen gonoccocal arthritis though. Conjunctivitis and pharyngitis yes, but nothing systemic and affecting a joint. That is exceedingly rare. Thanks for your own pearl of wisdom here!

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