0071643192.pdf

ORTHOPEDICS

TREATMENT

■ Emergent spine consultation

COMPLICATIONS

■ Permanent loss of bladder/bowel function
■ Leg weakness

JOINT ABNORMALITIES

A 26-year-old male comes into the ED with a fever; a swollen, painful right

knee and left elbow; and a vesiculopustular lesions on his fingers. He had

been treated for an STD two weeks earlier. What is his diagnosis?

Gonococcal arthritis.

Arthritis

Arthritis is joint damage as a result of degeneration (eg, osteoarthritis), inflamma-
tion (eg, rheumatoid arthritis, gout), or infection. It is characteristically divided
into mono-articular, symmetric oligo-/polyarticular, and asymmetric oligo-/
polyarticular causes (see Tables 4.5, 4.6, and 4.7).

SYMPTOMS/EXAM

■ Swollen, tender joint(s)
■ Associated symptoms: Depending on etiology, look for urethritis, eye pain/
discharge, rash

TABLE 4.5. Causes of Monoarticular Arthritis

CONDITION JOINTSINVOLVED UNIQUEFEATURES TREATMENT

Septic Knee; unique sites in S. aureusis most common Antibiotics starting with

IVDU patients include organism. vancomycin

sacroiliac, sternoclavicular,

and intervertebral joints

Gout First MTP, knee Needle-shaped; negatively birefringent NSAIDs, steroid injection,

crystals; yellow when parallel and blue colchicine. Do not use

when perpendicular to polarizing light allopurinol for acute

attacks.

Pseudogout Knee, first MTP, wrist Rhomboid-shaped; positively birefringent NSAIDs, steroid

(chondrocalcinosis) crystals; blue when parallel and yellow injection

when perpendicular to polarizing light

Osteoarthritis Hip, knee Older age group, weight-bearing joints Rest, NSAIDs, joint

replacement surgery

Trauma Knee Hemarthrosis associated with Compression dressing

intra-articular fractures and and aspiration if necessary

ligamentous injury for symptomatic relief

A monoarticular arthritis

should be presumed to be

septic until proven otherwise.