Differentiating the source of inflammation or pain as articular (within the joint) or periarticular (outside the joint) is an important step in preventing iatrogenic inoculation. Other causes of septic arthritis include direct inoculation from either penetrating trauma or iatrogenic introduction of bacteria during procedural intervention and contiguous spread of a local infection including osteomyelitis, septic bursitis, and/or abscess. The migration of bacteria into a joint is facilitated by the lack of a basement membrane (or barrier) in the synovial tissues. The most common source of infection is hematogenous spread of bacteria from bacteremia. A predilection for large joints exists with as many as 60% of cases involving the knee or the hip (1).
Septic arthritis typically involves one joint, but can be polyarticular in up to 20% of cases. Bacterial arthritis, often used synonymously with septic arthritis, portends the most destructive course and should therefore bear weight on a clinician’s diagnostic considerations. In the absence of trauma, the differential is broad ranging from benign to potentially life-threatening.
The presentation of an acutely painful, warm, and/or swollen joint requires emergent evaluation. Heimann, MD (EM Resident Physician, University of Alabama at Birmingham Hospital) and Kevin Barlotta, MD (Attending Physician and Associate Professor of EM, University of Alabama at Birmingham Hospital) // Editors: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (EM Resident Physician at SAUSHEC USAF)įeatured on #FOAMED REVIEW 46TH EDITION – Thank you to Michael Macias from emCurious ( for the shout out!
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