Septic arthritis in a collegiate football player

A 23-year-old collegiate football player reported to the training room the day after a game, complaining of severe pain in his right shoulder. He recalled no significant injury during the game. Physical examination revealed pain, tenderness, and apprehension with all attempts to palpate or move the joint. There was no obvious effusion, redness, or warmth about the shoulder joint. The neurovascular examination was negative, and x-rays revealed no fracture. The patient's temperature was 102 degrees F. The team orthopedist aspirated 10cc of purulent fluid from the joint. Subsequent analysis revealed a white cell count greater than 50,000 mm(3), but no organisms were seen. The diagnosis of septic arthritis was made on the basis of the elevated cell count of the joint aspirate, in conjunction with fever (102 degrees F) and the clinical findings of an excessively painful joint. The patient was admitted for arthroscopic irrigation and debridement of the joint. Cultures subsequently showed a light growth of a Gram-negative organism. The patient was treated initially with intravenous broad-spectrum antibiotics and was ultimately discharged and put on oral antibiotics at the time of discharge. Rehabilitation followed the usual protocol for diagnostic arthroscopy, and the patient made an excellent recovery. He has had no residual sequelae or recurrence of infection.