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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

Ann Emerg Med 2009 Nov 8;54(5):695-700. Epub 2009 Aug 8.

Department of Emergency Medicine, Alameda County Medical Center-Highland Campus, Oakland, CA 94602, USA.

Study Objective: We determine the proportion of methicillin-resistant Staphylococcus aureus (MRSA) in adult septic arthritis patients presenting to the emergency department (ED).

Methods: This was a cross-sectional retrospective review in 2 urban academic EDs in northern California, one tertiary care and one public. Subjects included patients who underwent arthrocentesis in the ED from April 2006 through July 2007. Read More

J Clin Rheumatol 2009 Jun;15(4):185-9

San Antonio Uniformed Services Health Education Consortium, Rheumatology Service, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA.

The ruptured popliteal synovial cyst is a common complication of chronic knee arthritis. In contrast, non-popliteal synovial rupture is less well recognized and may present a diagnostic dilemma. We report an 81-year-old woman who presented with chest wall pain and ecchymosis. Read More

Orthopedics 2008 Aug;31(8):809

Department of Pediatric Orthopedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy.

Septic arthritis of the shoulder in children is a rare condition. The diagnosis may present some difficulties and, consequently, appropriate treatment often is delayed. Main sequelae are humeral shortening, joint instability, premature arthritis and limited range of motion. Read More

J Rheumatol 2008 Oct;35(10):2083-4

Curr Probl Diagn Radiol 2008 Sep-Oct;37(5):203-18

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

Ultrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Read More

Reumatismo 2008 Jan-Mar;60(1):1-5

U.O.C. di Reumatologia, Azienda Ospedale-Università, 35128 Padova, Italia.

Septic arthritis (SA) is a clinical emergency with considerable morbidity and mortality that can lead to rapid joint destruction and irreversible loss of function. The reported incidence varies from 2-5 cases per 100.000 individuals per year in the general populations to 70 cases per 100. Read More

Nihon Ronen Igakkai Zasshi 2007 Nov;44(6):761-6

Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo.

We report a 77-year-old woman with Group B streptococcal bacteremia, subcutaneous abscess and reactive polyarthritis. Two years previously she suffered from atrial fibrillation and osteoarthritis of the knee. After she was admitted for treatment of the knee joint with hyaluronate sodium, she complained of pain in the left shoulder and both knees. Read More

J Emerg Med 2007 Apr 22;32(3):295-7. Epub 2007 Feb 22.

Drexel University College of Medicine, Philadelphia, Pennsylvania 19140, USA.

This article reports the case of a 52-year-old woman with septic arthritis and bursitis of her shoulder. Due to a minor musculoskeletal injury and lack of fever, the diagnosis was missed on her first Emergency Department visit. Sonographic guidance of the shoulder arthrocentesis led to successful aspiration of the larger fluid collection in the subacromial bursa and allowed the diagnosis and treatment to proceed more rapidly. Read More

Am J Vet Res 2007 Mar;68(3):283-9

Department of Diagnostic Imaging of Domestic Animals, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, 9820 Merelbeke, Belgium.

Objective: To evaluate anticollagen type I antibodies in synovial fluid of the affected stifle joint, the contralateral stifle joint, and the left shoulder joint of dogs with unilateral cranial cruciate ligament (CrCL) rupture during an extended period of 12 to 18 months.

Animals: 13 client-owned dogs with CrCL rupture and 2 sham-operated dogs.

Procedures: All dogs were examined and arthrocentesis of all 3 joints was performed every 6 months after surgery. Read More

J Radiol 2005 Dec;86(12 Pt 2):1911-23

Département d'Imagerie Médicale, CHRU de Dijon, BP 77908, 21079 Dijon.

Diagnostic and therapeutic interventional procedures are rapidly expanding and, when guided by imaging, are more efficient then when performed with a blinded technique. Compared to fluoroscopy and CT, ultrasound does not utilize ionizing radiation. It can facilitate needle placement for arthrography, tenography or bursography or it can guide a variety of procedures such as aspiration, arthrocentesis, local steroid injections and needling of tendon calcifications. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2005 Jul;19(7):551-3

Department of Orthopedics, East Hospital Affiliated to Tongji University, Shanghai, 200120, P. R. China.

Objective: To evaluate the clinical importance of double contrast CT diagnosis of traumatic anterior shoulder instability.

Methods: Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. Read More

Reumatismo 2005 Apr-Jun;57(2):69-77

Unità Operativa di Reumatologia, IRCCS Policlinico San Matteo, Piazzale Camillo Golgi 19, Pavia, Italy.

Milwaukee shoulder is a well defined clinical entity that can be observed in particular in older women. It is a destructive arthropathy associated with the deposition of calcium pyrophosphate dihydrate crystals, characterized by the presence of large amount of synovial fluid and a complete tear of the rotator cuff. Clinical features include pain, swelling and progressive functional impairment. Read More

J Am Vet Med Assoc 2004 Dec;225(12):1866-70

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108, USA.

Objective: To determine absolute and relative cell counts for synovial fluid from grossly, radiographically, and histologically normal shoulder and stifle joints in healthy cats.

Design: Clinical study.

Animals: 52 cats scheduled to be euthanatized for unrelated reasons. Read More

Radiol Med 2003 Sep;106(3):201-12

Dipartimento di Radiologia, Ospedale Civile di Conegliano (Treviso).

Purpose: The aim of this study is describing fluoroscopic techniques with multislice CT during interventional procedures. We emphasize the technical principles of the multislice CT fluoroscopy and the relative advantages in clinical application, in comparison to single slice fluoroCT and conventional CT guided procedures. Other topics are dosimetry and patient's and operator's radioprotection. Read More

J Gen Intern Med 2002 Jun;17(6):441-5

Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242, USA.

Objective: We developed an instructional program to teach aspiration and injection techniques of the knee and shoulder to medical students and residents.

Methods: Residents and fourth-year medical students participating in a rheumatology elective were assigned by deterministic allocation into 3 groups: the Traditional group received no specific instruction in arthrocentesis but simply rotated through rheumatology, learning injection techniques only if they saw patients who required them; the Lecture-only group received only the didactic lecture and did not have the opportunity to practice on the models; the Program group participated in the newly developed program of instruction that combined a didactic lecture and a hands-on workshop using the anatomic models to practice arthrocentesis techniques.

Results: The scores on the written examination for those in the Program group (mean score 37. Read More

Panminerva Med 2002 Jun;44(2):151-4

Department of Radiological and Orthopaedic- Rehabilitative Sciences, Orthopaedic and Traumatologic Clinic, University of Siena, Siena, Italy.

Septic arthritis due to Streptococcus Pneumoniae appears to be relatively uncommon. Single- or clustered-case histories constitute the majority of reports on pneumococcal septic arthritis. A 70-year-old man presented with a 7-day history of pain, erythema and swelling of the left shoulder. Read More

J Am Vet Med Assoc 1995 Jul;207(2):201-7

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul 55108, USA.

Medical records of 23 dogs with unilateral and 3 dogs with bilateral chronic bicipital tenosynovitis were reviewed. Mean age of affected dogs was 4.6 years (SD, 2. Read More

Schweiz Med Wochenschr 1992 Jun;122(25):969-74

Rheumatologische Universitätsklinik, Inselspital, Bern.

The diagnostic clarification of joint effusions of unknown origin is a challenge to every primary-care physician. Important diagnostic procedures are arthrocentesis and analysis of the aspirated synovial fluid. Synovial fluid analysis frequently allows differentiation between harmless effusions due to osteoarthritis and crystal induced inflammation, or the more devastating septic arthritis. Read More

J Fam Pract 1985 Feb;20(2):179-84

Aspiration of the synovial joints is an important part of the diagnostic and therapeutic armamentarium of the physician and may provide vital information that can be obtained in no other way. As with any other technique in medicine, skill and safety in the aspiration of joints can be acquired only through careful study and continued practice in arthrocentesis. When appropriate preparations and precautions are observed, obtaining fluid from synovial joints is safe, relatively pain free, inexpensive, and extremely beneficial to the patient. Read More

Schweiz Med Wochenschr 1977 Aug;107(33):1170-2

Three patients with hemarthrosis complicating anticoagulant therapy are described. Two had acute hemarthrosis of the knee joint occurring during long term oral anticoagulant therapy for cardiovascular disorders. Joint symptoms disappeared rapidly after arthrocentesis and diminution of the dose of oral anticoagulant medication. Read More

Vet Clin North Am 1974 May;4(2):449-62

Surg Clin North Am 1969 Dec;49(6):1269-78