A young woman presents with a painful wrist, no trauma history. On exam, there is an effusion present, no erythema and tenderness to palpation. She is afebrile. How do you rule out a septic joint? What pathogen should be considered?

 

 

Do an athrocentesis. We don’t aspirate a lot of wrists. Or ankles. Or elbows. Or shoulders.

You can place her wrist in ulnar deviation and mild flexion. Insert a 22gauge needle just distal to Lister’s tubercle and at the ulnar aspect of the extensor pollicis longus tendon.

Check out these links (and others):
http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79928-80032-1477044tn.jpg
http://reference.medscape.com/features/slideshow/arthro-practice (this one has other joints as well)

Remember gonorrhea in the sexually active population (age indiscriminate). Be sure to ask your lab technician for Thayer-Martin plating, so you don’t miss it.