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This article presents an exceptional clinical manifestation of gout in the wrist. The patient suffered from an association of septic and urate-crystal-induced arthritis. At the time, the serum uric acid concentration was still normal. The association of septic and urate-crystal-induced arthritis has been reported in other locations. The pathophysiology of the precipitation of urate crystals in the presence of an infectious process is discussed.

Os acromiale is an unfused epiphysis of the anterior part of the acromion occurring in approximately 8% of the population. Infection of this joint has not been previously described in the literature. We report such a case in a 59-year-old woman presenting with shoulder pain. A high index of clinical suspicion, with early imaging of the shoulder leading to prompt and definitive diagnosis, can lead to appropriate treatment and produce a favorable outcome.

Purpose: Accurate diagnosis of acute painful swollen wrists can be difficult. We aimed to identify the differentiating clinical and laboratory parameters for septic and suspected infectious arthritis of the wrist.

Methods: This retrospective study reviewed and compared the data of 49 patients (55 wrists) with synovial fluid white blood cell (WBC) counts ¿20,000/mm³. 25 patients with 29 septic wrists with positive staining or culture results, and 24 patients with 26 suspected infectious wrists.

Results: Patients with suspected infection underwent fewer operations (1.0 versus 2.1 times) and required shorter periods of hospitalization (34.0 versus 49.7 days) than those with septic wrists. C-reactive protein (CRP) levels before treatment, and postoperative day five for suspected infectious arthritis were lower than those for septic arthritis. Diabetes was more prevalent in patients with septic arthritis (13/25) than those with suspected infection (2/24). However, the average synovial WBC count and average highest temperature before treatment were not different between the two groups.

Conclusions: Patients with suspected infectious wrists had lower initial CRP levels and a lower prevalence of diabetes. However, the initial synovial WBC count and body temperature were similar, implying that the initial management of suspected arthritis should be similar to that of septic arthritis.

Background: The objective of this study was to determine prognostic factors affecting the clinical outcome of septic arthritis of the shoulder.

Methods: We retrospectively reviewed 34 shoulders from 32 patients, two of which had bilateral involvement. Arthroscopic (22 shoulders) or open surgery (12 shoulders) was performed by a single surgeon. The mean follow-up period was 32.4 ± 17.0 months. Clinical outcomes according to the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) were assessed at the final follow-up period. Various factors were included for statistical analysis.

Results: The mean UCLA, ASES scores, and SSV were 28.9 ± 7.2, 81.3 ± 21.0, 79.7 ± 2.5%, respectively. Positive culture was observed in only 13 shoulders (38.2%) and the most common organism was Staphylococcus aureus (seven shoulders). Five shoulders (14.7%) required two or three operations. Age and comorbidity were negatively correlated with the UCLA, ASES score, and/or SSV (p < 0.05). There was no correlation between clinical outcome and various parameters, including gender, location of lesion, history of previous steroid injection, interval between onset of symptoms and surgical intervention, bacterial organisms, operative method, and presence of rotator cuff tear and reoperation (p > 0.05).

Conclusions: Both arthroscopic and open surgery for septic shoulders showed satisfactory clinical outcomes. Old age and comorbidity were poor prognostic factors of clinical outcomes after treatment.

Background: Current guidance for the management of septic arthritis is limited to large joints and, therefore, unspecific to the small joints of the hand, which may present differently, require different diagnostic approaches, and have different complications. The aim of this article was to review current treatment trends for the management of small joint septic arthritis (SJSA) of the hand and offer guidelines for its management.

Methods: A systematic review was carried out according to PRISMA guidelines and a survey distributed to Fellows of the British Society for Surgery of the Hand to establish expert opinion. The review and survey were combined to present a set of specific SJSA of the hand infection guidelines.

Results: All 20 included studies recommended physical drainage of infected joint fluid; subsequent lavage and early antibiotic therapy, with physiotherapist-guided joint mobilisation. Statistical analysis of the 77 responses to our survey revealed that (in order of preference) the diagnosis was made by history and examination, blood tests, joint aspiration and vital signs; and for interventions: joint elevation and intravenous antibiotics; then joint washout repeated within 48 hours, if necessary.

Conclusions: Small joint infection differs from large joint infection because it is difficult to obtain joint aspirate without damaging or opening the joint. We, therefore, recommend utilising exclusion blood tests, imaging and the clinical picture to establish the diagnosis and implement early treatment and rehabilitation.

Level of Evidence: Level III