MANUAL MINORS
Septic arthritis of the hand is a serious infection of one or more joints in the hand, typically caused by bacteria, with Staphylococcus aureus being the most common pathogen. The infection can result from haematogenous spread, penetrating wounds, surgeries, or the extension of adjacent infections. Septic arthritis requires urgent treatment to prevent permanent joint damage and systemic complications.
Diagnosis
The diagnosis is based on the clinical presentation, which includes:
Severe pain in a joint, worsened by movement.
Swelling and erythema over the affected joint.
Local warmth.
Limited range of motion due to pain.
Fever and general malaise in advanced cases.
Definitive diagnosis is made by aspirating the synovial fluid for microbiological analysis, which will reveal the presence of bacteria, inflammatory cells, and the characteristics of the fluid (cloudy, purulent). X-rays may show soft tissue swelling and, in advanced stages, joint destruction.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Pyogenic Flexor Tenosynovitis | Localised pain along the flexor tendons with semi-flexed fingers, without direct joint involvement. |
Rheumatoid Arthritis | Chronic pain and morning stiffness in multiple joints, without acute signs of infection. |
Gout | Acute joint pain without infectious signs, with urate crystals present in the synovial fluid. |
Cellulitis | Superficial soft tissue infection without intra-articular involvement. |
Emergency Management
Immobilisation of the affected hand to reduce pain and prevent further damage.
Aspiration of the affected joint under sterile conditions to obtain synovial fluid for analysis and culture.
Immediate administration of broad-spectrum intravenous antibiotics following aspiration, adjusted later based on culture results.
Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) or stronger analgesics depending on the severity of the pain.
Elevation of the hand to reduce swelling.
Definitive Treatment
Definitive treatment involves joint drainage, either through repeated aspirations or surgical drainage in severe cases. Intravenous antibiotic therapy is continued for 2-4 weeks, depending on clinical progress and microbiological results. In cases of significant joint destruction, surgical debridement may be required. Physical rehabilitation is crucial to restore range of motion and hand functionality.
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