Monthly Archives: March 2016

Septic Arthritis

Thank you Dr. John Hollowed for a great presentation of a pain with acute onset R. shoulder and L. knee pain/swelling s/p arthrocentesis c/w infectious process (gram stain with GPC’s, WBC >200K). Patient also likely with native valve endocarditis

Teaching Points: 

–Septic arthritis an orthopedic emergency! Consult ortho as patient may require surgical irrigation and debridement

–Oligoarticular or polyarticular infection occurs in approximately 20 percent of septic joint infections, usually involving two or three joints.

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Diabetic Myonecrosis

diabetic myonecrosis

Thank you Dr. Jane Ma for a a great presentation of a woman with right thigh pain and swelling, found to have diabetic myonecrosis

Teaching Points: 

  • Rare complication associated with poorly-controlled DM caused by infarcted muscle tissue
  • Acute pain and swelling of the affected muscle, most often in the lower extremities (most commonly in the thigh, second most common is calf pain/swelling)
  • Usually no history of trauma or fever
  • Usually in patients with poor glycemic control and complications of that (nephropathy, retinopathy, neuropathy)
  • MRI: imaging study of choice
  • Must rule out infectious causes, often with a CT-guided biopsy (ie. pyomyositis)
  • Muscle biopsy: can give you a definitive diagnosis but not currently recommended due to risks of complications from procedure and increase in time to recovery
  • Management: Conservative: Rest, pain control, NSAIDs