Septic Arthritis in Paediatric Patients: A 10-year Experience at a Single Institution

Background We evaluated the clinical presentation and microbiological profile of a cohort of paediatric patients with septic arthritis at a tertiary institution in Singapore. Methods After obtaining institutional board approval, records of all patients below 18 years presenting with septic arthritis between 2010 and 2019 were reviewed. Patient demographic and medical data were analysed. Results Of 24 patients with 26 infected joints with a mean age of 7.1 years, 50.0% had pre-existing atopic dermatitis. The most common site infected was the hip ( n = 11, 42.3%). The most common pathogen isolated from tissue cultures was methicillin-sensitive-Staphylococcus aureus (MSSA) ( n = 9, 37.5%). Twenty-three (95.8%) of the patients underwent surgical drainage. Conclusions The skin of patients with atopic dermatitis has been shown to be more frequently colonised with Staphylococcus aureus compared to healthy individuals. The prevalence of atopic dermatitis in our cohort was higher compared to the reported national average of 20.8%. MSSA was the most commonly reported pathogen, and the hip joint most commonly affected. Less than half of the cohort had positive tissue or blood cultures. In paediatric patients with known atopic dermatitis who present with a fever, a painful joint and limited range of motion, septic arthritis should be considered and early drainage and antibiotics instituted.

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Polyarticular Septic Arthritis in an Immunocompetent Adult: A Case Report and Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2015/602137 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Annelise Miller ◽

Fahad Abduljabbar ◽

Peter Jarzem

Keyword(s):

Staphylococcus Aureus ◽

Case Report ◽

Septic Arthritis ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Limited Range ◽

Left Shoulder ◽

Immunocompetent Adult ◽

Limited Range Of Motion ◽

Healthy Adult Male

Septic arthritis is a clinical emergency requiring prompt diagnosis and treatment to avoid significant morbidity and mortality. Polyarticular septic arthritis (PASA) accounts for 15% of all infectious arthritides and rarely occurs in immunocompetent adults.Staphylococcus aureusis the most commonly isolated organism, with infection primarily affecting knees, shoulders, elbows, and hips. The morbidity associated with PASA is very high, and mortality in treated cases of PASA may be as high as 50% of cases. We report a case of PASA with associated epidural abscess in a healthy adult male, who presented with complaints of arthralgia and limited range of motion of his left shoulder, wrist, and ankle. He also presented with low back pain and motor weakness associated with an epidural abscess spanning L2-S1, with multilevel vertebral osteomyelitis. Surgical washout of the affected joints as well as decompressive laminectomies was performed, and he received a standard course of intravenous antibiotics.Staphylococcus aureuswas isolated from joint aspirations and from blood cultures. The patient had a full neurological and functional recovery postoperatively with no sequelae. To the best of our knowledge this is the only case report ofStaphylococcus aureusPASA with concomitant epidural abscess in an immunocompetent adult.

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The Rare Lateral Cuneocuboid Coalition: A Case Report

Journal of the American Podiatric Medical Association ◽

10.7547/17-018 ◽

2019 ◽

Vol 109 (3) ◽

pp. 231-234

Author(s):

Eric So ◽

Kevin Renner ◽

Amanda Quisno ◽

Daniel Logan

Keyword(s):

Case Report ◽

Clinical Presentation ◽

Limited Range ◽

Activity Level ◽

Resonance Imaging ◽

Pes Planus ◽

The Third ◽

Limited Range Of Motion ◽

The Common

Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity. The focus of this case report includes the presentation, imaging, treatment, and outcomes for a 21-year-old woman diagnosed with a rare lateral cuneocuboid coalition with chronic pain. Clinical and radiographic examinations, typically used to diagnose the common coalition, were unremarkable. Magnetic resonance imaging was diagnostic of the lateral cuneocuboid coalition, which was successfully treated with surgical resection. At 6-year follow-up, she reports resolution of symptoms and has returned to her normal presurgical activity level pain-free. This case is only the third lateral cuneocuboid coalition reported in the literature. The rarity of this coalition and its nonsuspicious clinical presentation make it worthy of acknowledgment.

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Septic arthritis of multiple native joints following tooth extraction

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214691 ◽

2021 ◽

Vol 7 (12) ◽

pp. 1937

Author(s):

Chidambar Siddegowda ◽

Nalina Nanjundappa ◽

Sharanbasappa Japatti ◽

Akshaya Subramanian

Keyword(s):

Septic Arthritis ◽

Tooth Extraction ◽

Joint Infection ◽

Third Molar ◽

Limited Range ◽

The Body ◽

Third Molar Extraction ◽

Limited Range Of Motion ◽

Mandibular Third Molar ◽

Molar Teeth

<p>Infection of the distant parts of the body especially the joints after a tooth extraction is uncommon, but when it occurs due to the virulence of the organism or due to the risk factors, it may cause severe joint infection with abscess formation and may limit the movements. We report a case of arthritis of the knee joint along with involvement of other joints following mandibular third molar teeth extraction one week postoperatively. The patient had swelling and limited range of motion of the involved joints, pain over other multiple joints. The patient had two episodes of postoperative septic arthritis following each mandibular third molar extraction. He was diagnosed of having septic arthritis and treated with antibiotics, analgesics, and steroids, that resolved after 3 weeks. </p>

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Calcium pyrophosphate dihydrate crystal deposition disease and MRSA septic arthritis of the atlantoaxial joint in a patient with Tourette syndrome

BMJ Case Reports ◽

10.1136/bcr-2018-228102 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228102

Author(s):

Edward Nicholas Northrup ◽

Benjamin Robert Pflederer

Keyword(s):

Neck Pain ◽

Septic Arthritis ◽

Tourette Syndrome ◽

Cervical Vertebrae ◽

Limited Range ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Atlantoaxial Joint ◽

Crystal Deposition ◽

Limited Range Of Motion

A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. He exhibited cervical spinal and paraspinal tenderness with very limited range of motion. Erythrocyte sedimentation rate and C reactive protein were elevated, and blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Lumbar puncture was unremarkable. CT and MRI of the neck showed calcification of the longus colli, fluid and capsular distention of C1–C2 joints, enhancement of the joint capsule and retropharyngeal oedema suggestive of septic arthritis. Fluid was aspirated from C1 to C2 joint by interventional radiology and showed calcium pyrophosphate crystals and heavy MRSA colonisation, consistent with both pseudogout and septic arthritis of the cervical vertebrae. The patient was started on a 6-week course of daptomycin and showed gradual improvements in neck pain and mobility.

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Impairment Tutorial: Rating Tears of the Acetabular Labrum

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.novdec02 ◽

2006 ◽

Vol 11 (6) ◽

pp. 4-7

Author(s):

Charles N. Brooks ◽

Richard E. Strain ◽

James B. Talmage

Keyword(s):

Magnetic Resonance ◽

Hip Arthroscopy ◽

Age Groups ◽

Limited Range ◽

Labral Repair ◽

X Rays ◽

Joint Stability ◽

Acetabular Labrum ◽

Complete Excision ◽

Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

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The Correlation of the Limitations of Movement of the Shoulder Joint with the Functional Ability of Frozen Shoulder Patients at the Medical Rehabilitation Institute Dr. Mohammad Hoesin Palembang

SRIWIJAYA JOURNAL OF MEDICINE ◽

10.32539/sjm.v3i3.218 ◽

2020 ◽

Vol 3 (3) ◽

pp. 88-96

Author(s):

Ine Sintia ◽

Nyimas Fatimah

Keyword(s):

Functional Ability ◽

Shoulder Joint ◽

Frozen Shoulder ◽

Limited Range ◽

Medical Rehabilitation ◽

Cross Sectional ◽

Shoulder Joints ◽

Limited Range Of Motion ◽

Active Flexion ◽

Cross Sectional Design

Background: Frozen shoulder is a condition of the shoulder joint that experiences inflammation, pain, adhesions, atrophyand shortening of the joint capsule resulting in limited motion. In frozen shoulder patients, the limited range of motion ofthe shoulder joint can affect and reduce functional ability. This study aims to analyze the correlation between the limitedarea of motion of the shoulder joint with the functional ability of frozen shoulder patients at the Medical RehabilitationInstallation Dr. Mohammad Hoesin Palembang. Methods: This study was an observational analytic study, correlationtest, with a cross sectional design. There were 29 frozen shoulder patients who met the inclusion criteria in the MedicalRehabilitation Installation Dr. Mohammad Hoesin Palembang in November 2018 was taken as a sample using consecutivesampling techniques. Functional ability was assessed using the quickDASH questionnaire and the area of motion wasmeasured using a goniometer, then analyzed. Results: The results of the correlation test showed significant resultsbetween functional abilities and the area of motion of the shoulder joints. Active flexion (p = 0.000; r = -0.669), activeextension (p = 0.004; r = -0.520), active abduction (p = 0.000; r = -0.663), active adduction (p = 0.022; r = -0.423 ), passiveflexion (p = 0.001; r = -0.589), passive extension (p = 0.002; r = -0.543), passive abduction (p = 0.000; r = -0.676), passiveadduction (p = 0.038; r = -0.388). Conclusion: There is a significant correlation between limited joint motion andfunctional ability in frozen shoulder patients at the Medical Rehabilitation Installation of Dr. Mohammad HoesinPalembang

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Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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