Septic arthritis is an acute infection of a joint, most commonly bacterial from hematogenous seeding as a complication of bacteremia. It is potentially life-threatening and has a mortality rate approaching 10%. An acutely warm, tender, and swollen joint with restricted movement due to pain should be considered septic until proved otherwise. Sternoclavicular joint (SCJ) septic arthritis is a rare process associated with intravenous drug abuse, diabetes, rheumatoid arthritis, and immunosuppressed individuals. Staphylococcus aureus is the most common cause.
Management and Disposition
Contrast-enhanced CT scan of the chest may demonstrate if the infection extends beyond the joint. Arthrocentesis is necessary to confirm the diagnosis. Synovial fluid should be sent for cell count and differential, culture and sensitivity, crystals, and Gram stain. Patients with septic arthritis should be admitted for surgical debridement and intravenous antibiotics.
Sternoclavicular Joint Septic Arthritis. Fever, erythema, tenderness, and fluctuance over the right sternoclavicular joint in a patient with intravenous drug use. Contrast-enhanced chest CT confirms fluid in the joint with overlying abscess. (Photo contributor: Kevin Barlotta, MD.)
Sternoclavicular Joint Septic Arthritis-CT. Axial cut of a contrast-enhanced chest CT in patient 7.89A reveals a right SCJ septic arthritis with abscess formation. (Photo contributor: Kevin Barlotta, MD.)
Sternoclavicular Joint Septic Arthritis. Elderly male with septic arthritis of the right SCJ joint as a remote complication of coronary artery bypass graft surgery. (Photo Contributor: Lawrence B. Stack, MD.)
Sternoclavicular Joint Septic Arthritis. Axial contrast-enhanced CT through the sternoclavicular joint of the patient in Figure 7.90A revealing swelling and abscess formation of the right sternoclavicular joint. (Photo Contributor: Lawrence B. Stack, MD.)
Sternoclavicular septic arthritis is associated with intravenous drug abuse.
Early surgical debridement should follow initiation of appropriate antibiotics.
Complications of septic SCJ include mediastinitis and SVCS.