Lyme Arthritis of the Pediatric Elbow: A Case Series.

Lyme Arthritis of the Pediatric Elbow: A Case Series. Orthopedics. 2018 May 16;:1-5 Authors: Gendelberg D, Hennrikus WL Abstract Most patients with untreated Lyme disease will experience joint symptoms. Owing to their resemblance in clinical presentation, Lyme arthritis and septic arthritis are often difficult to differentiate. However, their treatment is different. The elbow is rarely the first joint to present with symptoms. Therefore, Lyme disease is not commonly included in the differential diagnosis for children presenting with isolated elbow pain. The authors report 4 cases of monoarticular Lyme arthritis presenting in the elbow. There was an average delay of diagnosis of 4.75 days. Three cases were treated with oral antibiotics alone; 1 case was treated with unnecessary surgery due to uncertainty of the diagnosis and the delay in the laboratory performing the Lyme serology tests. The authors strongly recommend that Lyme serology be performed on an emergent basis to prevent unneeded surgery. [Orthopedics. 201x; xx(x):xx-xx.]. PMID: 29771396 [PubMed - as supplied by publisher]
Source: Orthopedics - Category: Orthopaedics Authors: Tags: Orthopedics Source Type: research

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Purpose of review To review the clinical diagnosis, management and natural history of septic arthritis of the hip (SAH) in the pediatric patient, and to highlight new information that may improve the management of these patients. Recent findings The basics of management of possible pediatric SAH have remained largely unchanged for generations. New questions have been raised regarding the role and timing of advanced imaging (MRI) in the evaluation of patients with possible SAH. Published criteria have been derived to guide the need for MRI studies in these patients. Validation of these guidelines continues. Recent revi...
Source: Current Opinion in Pediatrics - Category: Pediatrics Tags: ORTHOPEDICS: Edited by Daniel W. Green Source Type: research
Septic arthritis is a dangerous medical condition associated with significant morbidity and mortality. However, the differential diagnosis can be broad with conditions that mimic this disease and require different evaluation and treatment. This narrative review presents the emergency medicine evaluation and management, as well as important medical conditions that may mimic this disease. Septic arthritis commonly presents with monoarticular joint pain with erythema, warmth, swelling, and pain on palpation and movement. Fever is present in many patients, though most are low grade. Blood testing and imaging may assist with th...
Source: Western Journal of Emergency Medicine - Category: Emergency Medicine Source Type: research
Background: Lyme arthritis (LA) of the hip can present similarly to septic arthritis (SA) and transient synovitis (TS). The primary purpose of this study was to determine clinical and laboratory parameters differentiating LA of the hip from SA or TS among children who had undergone hip aspiration during the evaluation of hip pain. Methods: This was a retrospective review of all patients who underwent hip aspiration for the evaluation of hip pain at a tertiary care children’s hospital in a Lyme endemic area. Clinical and laboratory data were reviewed and comparative analyses were performed between those diagnosed wit...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Selected Topics Source Type: research
Conclusions: Although septic arthritis of the knee and Lyme monoarthritis share common features that can make them difficult to distinguish clinically, the presence of pain with short arc motion, C-reactive protein of>4.0 mg/L, patient-reported history of fever, and age younger than 2 years were independent predictive factors of septic arthritis in pediatric patients. The more factors that are present, the higher the risk of having septic arthritis. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Source: JBJS - Category: Orthopaedics Authors: Tags: Infection, Pediatrics Scientific Articles Source Type: research
Abstract Differentiating septic arthritis of the pediatric hip from other causes of hip pain and effusion continues to present a diagnostic challenge for the clinician. Although septic arthritis traditionally has been reported to have a synovial white blood cell count of 75,000 cells/mm3 or greater, lower counts can be seen in this condition. In cases where a synovial sample has been obtained and the cell count falls in the intermediate range between 25,000 and 75,000 cells/mm3, it is unclear what proportion of these cases may be truly septic hips. In this evidence-based review, we examine Heyworth et al...
Source: HSS Journal - Category: Orthopaedics Source Type: research
Abstract A limp is defined as a deviation from a normal age-appropriate gait pattern resulting in an uneven, jerky, or laborious gait. It can be caused by pain, weakness, or deformity as a result of a variety of conditions. Transient synovitis is the most common diagnosis. Other causes of acute limp include contusion, foreign body in the foot, fracture, osteomyelitis, septic arthritis, reactive arthritis, and Lyme arthritis. Causes of chronic limp include rheumatic disease, dermatomyositis, acute rheumatic fever, inflammatory bowel disease, and systemic lupus erythematosus. Evaluation of a limping child should beg...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
CONCLUSION: Our results suggest that most investigations performed during the initial work-up in patients suspected transient synovitis of the hip are unnecessary and should routinely include only. PMID: 26295841 [PubMed - as supplied by publisher]
Source: Swiss Medical Weekly - Category: Journals (General) Authors: Tags: Swiss Med Wkly Source Type: research
Publication date: Available online 4 August 2015 Source:Joint Bone Spine Author(s): Valérie Devauchelle-Pensec, Matthias Thepaut, Romain Pecquery, Laetitia Houx Monoarthritis, defined as inflammation of a single joint, requires a thorough physical examination in children, as pain may be lacking in 10% to 30% of cases and joint stiffness may be the only symptom. Joint aspiration is a crucial diagnostic tool that remains markedly underused. Joint aspiration may be unnecessary, however, when the family history or other investigations provide the diagnosis. Radiographs of the involved joint may supply information ...
Source: Joint Bone Spine - Category: Orthopaedics Source Type: research
Today you are the fast-track provider, and you are on the hunt for procedures. You notice a 35-year-old woman signing into triage with a chief complaint of wrist pain.   This patient looks otherwise healthy, is pushing a stroller with her right hand, and is carrying a second child on her left. What’s the emergency? There isn’t one, but it is an emergency to this patient because she cannot push that stroller another day! If she cannot push the stroller, then she cannot get the kids to day care. And, if she cannot get the kids to day care, then she cannot go to work. Ask anyone with children, it is an emerge...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
In this study, we sought to elucidate the presentation, clinical course, treatments pursued, final diagnosis, and risk factors for septic arthritis in a series of children with hip pain and intermediate synovial fluid values (white blood-cell [WBC] counts of 25,000 to 75,000 cells/mm3 [25 to 75 x 109 cells/L]). Methods: We reviewed the records of pediatric patients who underwent hip aspiration between 2005 and 2012 at a tertiary-care pediatric hospital. Demographic data, laboratory values, final diagnosis, and treatment details were recorded for the subpopulation of patients with an aspirate WBC count of 25,000 to 75,000 ...
Source: The Journal of Bone and Joint Surgery - Category: Orthopaedics Authors: Tags: Pediatrics Scientific Articles Source Type: research
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