An Algorithmic Approach to the Suspected Septic Wrist

Abstract: An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention. After a comprehensive literature review, we present evidenced-based guidelines and an algorithm for the management of the patient with an acutely inflamed wrist concerning for septic arthritis. For determining a diagnosis, systemic blood laboratory results are extremely variable and unreliable. Despite the attention given to the diagnostic potential of synovial fluid tests, the literature consistently demonstrates that diagnostic certainty cannot always be ascertained at the time of presentation based on aspiration fluid samples. Additionally, the investigative work does not necessarily end at the discovery of crystals since concomitant infection is a rare but well reported entity. Relative to larger joints, the wrist is far less likely to be infected and is easier to drain of debris, and therefore the empiric management of an inflamed wrist joint ...
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Hand Surgery Source Type: research