Septic Arthritis and Tenosynovitis Flashcards
What causes septic arthritis or tenosynovitis?
Iatrogenic, hematogenous, lacerations and punctures, local infection and idiopathic
What should you consider if you are suspicious of an iatrogenic cause of septic arthritis?
If you used a steroid you should be concerned of the immunosuppression and watch carefully for signs since they may not show for 2 weeks and be more mild than expected.
Treat all post-injeciton and post op lameness as an…
EMERGENCY
Who commonly suffers from a hematogenous origin of septic arthritis?
Foals
- umbilicus, lungs, GIT
How often should you check foal’s joints? How often should you check for lameness?
2x day for joint check
1x day for lameness
What are the clinical signs of septic arthritis?
Lameness, effusion, soft tissue edema/swelling, heat, pain on palpation and fever (not always in adults)
How do you diagnose septic arthritis?
HX, PE, Clin path (CBC, fibrinogen, serum amyloid A), Ultrasound, rads, CT, MRI, arthtocentesis
What should you be highly suspicious of when examining a foal?
Full exam
Effusion
Pain
Decreased Range of Motion
Listen to Lungs
Palpate umbilicus and abdomen
What are some clinical pathology findings that may suggest septic arthritis?
Increase WBC
Increase Fibrinogen (>1000mg/dl)
Increased Serum Amyloid A (>50mg/L)
What may you see on the ultrasound of a septic joint?
Increased synovial fluid, increased echogenicity, gas, thickened synovium, fibrin, soft tissue disruption and foreign body
What may you see on rads of Septic Arthritis?
Gas in synovial structure, tracking wound, foreign body, fracture, nail, osteomyelitis, physitis
Always visualize the nail on x-ray before you…
Pull it out
What would the synovial fluid look like in a normal joint?
TP <2.0 g/dl, WBC <450-5000/ul, Cell <10% neutrophils
What would an infected joints fluid cytology look like?
TP >4.0 g/dl, WBC >30,000ul, Cells >80% neutrophils
What are some common pathogens you may find on microbial culture of joint fluid?
Salmonella, strep zoo, e.coli, staph aureus, borrelia, clostridium, mycoplasma, fungal
What is a clean wound?
No sepsis, no inflammation (Surgical)
What is a clean contaminated wound?
Minor sepsis (break in sterility)
What is a contaminated
acute non-purulent inflammaiton (dumb GIT)
What is a dirty-infected wound?
Traumatic, devitalized, fecal contaminate, FB, puss (old wound)
What factors determine the prognosis of a septic arthritis?
Synovial structures involved, tendon and ligament, blood vessels, nerves, virulent bacteria, drug resistance of bacteria
Why can a puncture wound be worse than a laceration?
Bacteria and FB driven in deep, may not know in synovium, hard to assess depth and location, tract seals quickly
Is a synovial structure more painful when it is open or closed?
Closed (effusion swells and is painful)
How should you evaluate and clean a septic joint?
PE, sedated, sterile lube and clip, debride and lavage, no soap (iodine or chlorohex), palpate with gloves, ultrasound, rads, arthrocentesis, through and through lavage
What should your first line of defense be?
Broad spectrum antibiotics and lavage (penicillin and gentamicin systemic), intraarticular amikacin, regional limb perfusion with amikacin
