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Managing Small Joint Septic Arthritis of the Hand.
Teniola Adeboye1, Lolade Giwa2, Barbara Jemec3
1Department of Education, Broomfield Hospital, Chelmsford, UK.
The Journal of Hand Surgery Asian-Pacific Volume
|October 31, 2023
Summary
Small joint septic arthritis (SJSA) of the hand requires specific management distinct from large joints. Early diagnosis via clinical assessment, imaging, and blood tests, followed by prompt treatment and rehabilitation, is crucial for effective outcomes.
Area of Science:
- Orthopedics
- Infectious Diseases
- Hand Surgery
Background:
- Current septic arthritis guidelines inadequately address small joints of the hand.
- Small joint septic arthritis (SJSA) presents unique diagnostic and management challenges compared to large joints.
- This study aims to review treatment trends and propose guidelines for SJSA of the hand.
Approach:
- A systematic review adhering to PRISMA guidelines was conducted.
- Expert opinion was gathered via a survey distributed to the British Society for Surgery of the Hand.
- Guidelines were formulated by combining systematic review findings and expert survey results.
Key Points:
- All reviewed studies advocate for physical drainage of infected joint fluid, lavage, and early antibiotics.
- Physiotherapist-guided joint mobilization is recommended as part of the treatment.
- Expert consensus prioritizes history, examination, blood tests, and joint aspiration for diagnosis, with joint elevation and IV antibiotics as primary interventions.
Conclusions:
- Diagnosing SJSA is challenging due to difficulties in obtaining joint aspirates without joint damage.
- Recommended diagnostic approach includes exclusion blood tests, imaging, and clinical evaluation.
- Early implementation of treatment and rehabilitation is essential for managing SJSA of the hand.
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