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J Bone Joint Surg Am 2022 Jun 20. Epub 2022 Jun 20.

Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Background: Septic arthritis (SA) is a musculoskeletal emergency for which prompt diagnosis and treatment are critical. However, traditional diagnostic criteria of a synovial fluid (SF) white blood-cell count (WBC) of >50,000 cells/mm3 or >90% polymorphonuclear leukocytes (%PMN) are not particularly sensitive or specific for the diagnosis of SA. Furthermore, prognostic markers are lacking. Read More

Mod Rheumatol Case Rep 2022 Apr 25. Epub 2022 Apr 25.

Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan.

We experienced a case of bilateral shoulder bursitis with gas images in a rheumatoid arthritis (RA) patient. A 60-year-old man with RA had been treated with weekly methotrexate (MTX) 10 mg and daily prednisolone (PSL) 10 mg for 7 months. Generalized pain, especially in the bilateral shoulder joints developed and exacerbated daily with increased CRP level. Read More

Rom J Morphol Embryol 2021 Apr-Jun;62(2):615-619

Department of Immunology, Department of Biostatistics, University of Medicine and Pharmacy of Craiova, Romania;

Septic arthritis (SA) is a less common joint pathology with potentially fatal outcome. It is considered a medical emergency, in which prompt diagnosis and differentiation of bacterial etiology is essential for appropriate management. The knee is the most prevalent site for SA (~50% of cases), followed by hip, shoulder, and elbow. Read More

ACR Open Rheumatol 2022 Apr 6;4(4):312-321. Epub 2022 Jan 6.

University of Caen Normandy, Caen, France.

Objective: The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis.

Methods: Two groups of 15 medical students were each trained to perform a single joint arthrocentesis ("knee group" and "shoulder group") on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Read More

Mil Med 2021 Dec 4. Epub 2021 Dec 4.

Yale University, New Haven, CT 06520, USA.

Introduction: Recent epidemiological evidence shows that shoulder and upper-arm complaints impose a substantial burden on the armed forces of the United States and create significant challenges for all components of the physical fitness domain of total force fitness. Clinicians, epidemiologists, and health-services researchers interested in shoulder and upper-arm injuries and their functional limitations rarely have objective, validated criteria for rigorously evaluating diagnostic practices, prescribed treatments, or the outcomes of alternative approaches. We sought to establish and quantify patient volume, types of care, and costs within the Military Health System (MHS) in assessing and managing active duty members with nonoperative shoulder and upper-arm dysfunction. Read More

Am J Case Rep 2021 Nov 23;22:e933926. Epub 2021 Nov 23.

Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.

BACKGROUND The differential diagnosis of generalized pain includes reactivity associated with bacterial and viral infections, autoimmune rheumatic disease, and orthopedic diseases. Obtaining a detailed medical history and establishing an accurate diagnosis are difficult in elderly patients with dementia. In addition, the differential diagnosis between polymyalgia rheumatica and pseudogout is often difficult. Read More

Sci Rep 2021 11 11;11(1):22024. Epub 2021 Nov 11.

Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

A fluoroscopically controlled anterior approach in supine position is often used for arthrocentesis of the shoulder, but can lead to a high rate of dry aspirations. The aim of this study was to compare the aspiration performance of rigid needles and flexible catheters used with this approach. We hypothesized that a flexible catheter can significantly improve the amount of the obtained fluid. Read More

Mil Med 2021 Jul 28. Epub 2021 Jul 28.

Department of Rheumatology, Tripler Army Medical Center, Honolulu, HI 96859, USA.

Introduction: Military medical providers are a unique population that encounter different environments across the world. From hospital clinics to war zones, these providers must perform procedures and rely on their training and skill to help their patients. This pilot study aimed to assess the self-confidence of military medical providers performing joint aspiration and injection before and after a simulation workshop in both clinical and austere settings. Read More

BMJ Case Rep 2021 May 25;14(5). Epub 2021 May 25.

Internal Medicine, University of Miami Health System, Miami, Florida, USA.

A 68-year-old woman presented for left shoulder pain, decreased range of motion (ROM) and fever 7 days following COVID-19 vaccination. Investigations showed a tender left deltoid mass, decreased shoulder ROM and elevated inflammatory markers. MRI demonstrated a large glenohumeral effusion with synovitis, and arthrocentesis confirmed septic arthritis (SA). Read More

Int J Surg Case Rep 2021 Mar 24;80:105701. Epub 2021 Feb 24.

Community Memorial Health System, Ventura, CA, USA.

Introduction: Septic arthritis is an orthopedic emergency that requires rapid diagnosis and treatment due to the rapid destruction to cartilage. The responsible organism and etiology differs depending on patient age, especially in children. Gonococcal Arthritis in toddlers is a rare occurrence with few documented cases in the literature. Read More

Mod Rheumatol Case Rep 2021 07 25;5(2):384-386. Epub 2020 Nov 25.

Hospital Beatriz Ângelo, Loures, Portugal.

Musculoskeletal infections caused by are rare, but due to its multi-drug resistance has gained more and more attention from the scientific community. We report a case of a 81-year-old immunocompetent Caucasian female with a multifocal joint infection caused by this agent. Shoulder arthrocentesis and two different blood cultures were used to identify this vancomycin-resistant agent in a symptomatic patient. Read More

BMJ Case Rep 2020 Nov 4;13(11). Epub 2020 Nov 4.

Department of Internal Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

Mod Rheumatol Case Rep 2020 07 23;4(2):312-317. Epub 2020 Apr 23.

Nagasaki Diagnostic Pathology Clinic, Nagasaki, Japan.

Wild-type amyloidogenic transthyretin (ATTR) amyloidosis, known as systemic senile amyloidosis (SSA), is an age-related nonhereditary amyloidosis, which is known to cause cardiomyopathy and carpal tunnel syndrome (CTS). Herein, we report a case of unilateral hydrarthrosis with arthritis of the right shoulder joint in an 82-year-old Japanese housewife who has a seven year history of polyneuropathy due to an unknown aetiology. At first, her joint pain was thought to be caused by overuse of her right upper arm. Read More

BMJ Case Rep 2020 Sep 29;13(9). Epub 2020 Sep 29.

Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

A 72-year-old man with a history of right reverse shoulder arthroplasty presented with a 1-month history of erythema, pain and drainage from the right shoulder. Arthrocentesis was performed and synovial fluid gram stain revealed gram-positive rods. Clinical diagnosis of prosthetic shoulder joint infection was made. Read More

Ther Umsch 2020 Jun;77(5):213-217

Center da sandà Val Müstair, Sta. Maria V.M.

Arthrocentesis in the Emergency Department Acute joint swelling is a common presentation to the emergency department. Although routine investigations like clinical exam, labs and eventually x-ray are usually obtained, definitive diagnosis must be established since timely recognition of septic arthritis in particular is crucial. Definitive diagnosis is achieved by performing an arthrocentesis of the affected joint. Read More

Medicine (Baltimore) 2020 Aug;99(34):e21759

Department of Rehabilitation Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine.

Rationale: Subacromial-subdeltoid (SASD) bursitis is characterized by bursal distension caused by fluid collection, commonly resulting from rotator cuff tears. Aspiration of the bursal fluid associated with rotator cuff tears tends to be overlooked. The effects of combined bursal aspiration and corticosteroid injection on full-thickness tears of the rotator cuff with SASD bursitis have not been previously reported. Read More

Am J Med 2020 11 8;133(11):1283-1286. Epub 2020 Apr 8.

Department of Dermatology, Ramon y Cajal University Hospital, Madrid, Spain.

J Shoulder Elbow Surg 2020 Mar 25;29(3):516-520. Epub 2019 Sep 25.

Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

Background: Shoulder joint aspirations are frequently performed to rule out infection. In case of unsuccessful aspiration, physicians often augment the aspiration liquid by injecting saline solution.

Methods: We performed shoulder joint aspirations by fluoroscopic assistance and analyzed the value of an additional saline solution irrigation in patients undergoing revision shoulder surgery. Read More

South Med J 2019 04;112(4):238-243

From the Department of Internal Medicine, Yale University School of Medicine, New Haven, and the Department of Medicine, Section of Infectious Diseases, Veterans Affairs Healthcare Systems of Connecticut, West Haven.

Objective: To determine whether there are differences in the outcomes of native joint septic arthritis (SA) in adults, based on medical versus surgical management.

Methods: A 10-year retrospective single-center study was conducted of patients admitted to a tertiary care hospital between January 1, 2006 and December 31, 2015 with a diagnosis of SA to compare outcomes based on the management approach taken: medical (bedside closed-needle joint aspiration) versus surgical (arthrotomy/arthroscopy). Evaluated outcomes included joint recovery, time to recovery, length of stay, disposition to home versus rehabilitation unit, recurrence of SA in the same joint, and mortality. Read More

Orthopade 2018 Dec;47(12):1027-1031

Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, Zhejiang Province, China.

We present the case of a 91-year-old woman who presented with a 2‑day history of progressive pain and immobility of the right shoulder joint after fever of unknown etiology. Aeromonas sobria was isolated from a culture of purulent synovial fluid. The clinical condition gradually improved with the application of appropriate antibiotics and no surgical intervention was necessary. Read More

J Clin Rheumatol 2019 Jan;25(1):4-8

Traumatology Division, Puerta de Hierro Hospital, Madrid, Spain.

Objective: The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis.

Methods: In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016.

Results: A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Read More

Infect Dis Rep 2017 Oct 2;9(3):7185. Epub 2017 Oct 2.

Department of Medicine, Geisel Medical School at Dartmouth, Hanover, NH.

species are associated with normal skin flora and cultures may be dismissed as contaminants. They are increasingly recognized as a cause of septic arthritis following shoulder arthroplasty and arthrotomy. We identified three cases of septic arthritis in native joints mimicking atypical osteoarthritis and review the literature, clinical course, and treatment of 18 cases. Read More

J Am Acad Orthop Surg 2017 Aug;25(8):e175-e184

From the University of Chicago Medical Center, Chicago, IL (Dr. Jiang, Dr. Mass, Dr. Angeles, and Dr. Shi), and the University of Illinois at Chicago College of Medicine, Chicago (Dr. Piponov).

Introduction: In-hospital outcomes were compared among patients with shoulder septic arthritis treated with arthrocentesis, open irrigation and débridement, or arthroscopic irrigation and débridement.

Methods: The Nationwide Inpatient Sample database was queried for all cases of native shoulder septic arthritis between 2002 and 2011. Patient demographics, comorbidities, and hospitalization complications were compared for the shoulder arthrocentesis (nonsurgical) and open or arthroscopic irrigation and débridement (surgical) groups. Read More

J Grad Med Educ 2016 Jul;8(3):398-404

Background: Musculoskeletal (MSK) problems are common, and a recent US Bone and Joint Initiative calls for new models of education and professional collaboration. Evidence of feasibility and acceptability of innovative methods are needed.

Objective: We assessed if an experimental immersion interdisciplinary MSK curriculum would be acceptable to residents from different specialties, be feasible within existing rotations, and be effective in strengthening clinical skills. Read More

BMJ Case Rep 2016 Jun 2;2016. Epub 2016 Jun 2.

Royal Devon and Exeter Hospital, Exeter, UK.

A 69-year-old man with Klinefelter's syndrome presented with a painful shoulder and staphylococcal sepsis. He received intravenous antibiotics while investigations were performed to locate the source of infection. MRI demonstrated infection in the acromioclavicular joint (ACJ). Read More

J Clin Rheumatol 2012 Jun;18(4):175-9

Division of Rheumatology, The Hospital for Special Surgery-Weill Cornell Medical College, New York, NY, USA.

Background: Each year, rheumatology programs across the country teach incoming trainees the skill of arthrocentesis, but the relative effectiveness of various teaching techniques has not been assessed in a systematic way.

Objectives: We compared approaches to teaching arthrocentesis using cadavers versus anatomic models.

Methods: In a pilot study, new rheumatology fellows (n = 7) from 2 academic institutions were surveyed at 3 points during arthrocentesis training: (1) before assuming patient care; (2) after lecture with handouts, followed by practice either on cadavers (group A) or on synthetic joint models (group B); and (3) 6 weeks into fellowship. Read More

J Clin Rheumatol 2011 Apr;17(3):121-3

James A. Haley Veterans Administration, FL, USA.

Background: Arthrocentesis is an important skill for medical practitioners at all levels of training. Previous studies have indicated a low comfort level and performance of arthrocentesis among primary care physicians that could be improved with hands-on training.

Objectives: The objective of this study was to improve comfort with knee and shoulder arthrocentesis at all levels of medical training, including medical students, internal medicine residents, and rheumatology subspecialty residents, and in arthrocentesis of the elbow, wrist, and ankle for advanced subspecialty residents in rheumatology through the use of a formal workshop using simulators. Read More

Prim Care 2010 Dec;37(4):691-702, v

Family Medicine Residency Program, University of South Alabama, 1504 Springhill Avenue, Room 3414, Mobile, AL 36604, USA.

Athrocentesis and therapeutic joint injection is a safe and useful primary care procedure. Fluid collection and analysis from effused joints is important to establish a cause and therefore inform appropriate management. Therapeutic joint injection can give patients significant, rapid, localized pain relief. Read More

Radiologia 2010 Nov-Dec;52(6):525-33. Epub 2010 Oct 15.

Servicio de Radiodiagnóstico, Hospital de Basurto, Bilbao, España.

Ultrasonography is the most appropriate tool for interventional procedures in the musculoskeletal system when the lesion is visible on ultrasonography. Procedures performed under ultrasonographic guidance include: taking biopsies; draining abscesses; bursitis; hematomas or muscle tears; treating cystic lesions; diagnostic or therapeutic arthrocentesis; injecting substances into joints or lesions; aspirating calcium deposits and extracting foreign bodies. Although some of these procedures are often carried out without imaging guidance, ultrasonographic guidance improves their efficacy. Read More