Septic arthritis is a condition in which one or more joints are infected by a microorganism leading to an infective inflammation in the joint. Elbow joint septic arthritis occurs when there is an infection in the elbow, which results in an inflammatory process in the elbow and causes arthritis. As it is associated with an infection in the elbow joint, it is also called as elbow joint infective arthritis.
Normally, the synovial fluid in the elbow joint is sterile and free from any microorganisms. When there is an infection affecting the elbow joint, like in elbow joint septic arthritis, microorganisms appear in the synovial fluid and cause an inflammation in the elbow joint.
In elbow joint septic arthritis, only the elbow may be involved without any other joint involvement, or sometimes, the infection may also spread to other joints in the body.
Elbow joint septic arthritis often has a sudden onset of symptoms, which usually includes swelling, pain, redness and warmth of the elbow joint. Fever is commonly present along with other signs of infection.
What Causes Elbow Joint Septic Arthritis?
Elbow joint septic arthritis is caused due to the entry of microorganisms or germs into the joint. This can result from exposure to the microbes due to an injury or due to the entry of microbes into the bloodstream that can reach the elbow joints and infect them. Elbow joint septic arthritis is caused by microbes present in the body that spread to other areas in the body, particularly the elbow joint through the bloodstream.
Some of the common causes of elbow joint septic arthritis include:
- Infections – During an infection, the microbes attack the body and spread through the bloodstream. The commonest cause of elbow joint septic arthritis includes occurrence of infection in some part of the body, which can travel to another part or the elbow joint. This can occur after an episode of bacterial infection from streptococcus and staphylococcus; viral infections like influenza, mumps, hepatitis, herpes, HIV, etc. Some fungal infections too can cause elbow joint septic arthritis, by spreading through the bloodstream. Sometimes, in normal individuals, the bacteria present in the nose or the gut too can lead to spreading of the infection in the joints causing elbow joint septic arthritis.
- Injury – An open injury, cut or wound around the elbow joint can cause entry of the microbes into the joint. Any open injury in the body can cause entry of microbes into the bloodstream that can reach the elbow joint and cause elbow joint septic arthritis.
- Surgery – A surgical procedure, in which the wound is open can be a source of entry for the microorganism, which on entering into the bloodstream can cause elbow joint septic arthritis. Joint surgeries or investigations like arthroscopy, which involve intervention, can sometimes cause infection, which can spread to the elbow joint causing elbow joint septic arthritis.
The common organisms known to cause elbow joint septic arthritis include:
The commonest ones are Staphylococcus aureus and Streptococci. Neisseria gonorrhea – common cause of septic arthritis in sexually active young adults. Others include Escherichia coli, Mycobacterium tuberculosis, Salmonella, Brucella and Pseudomonas aeruginosa.
Haemophilus influenza, was common mostly in children until the Haemophilus vaccine came to be used.
Who is at Risk of Elbow Joint Septic Arthritis?
While it is possible for anyone to develop elbow joint septic arthritis, it can be more common in certain conditions. Children and elderly adults too are commonly known to suffer from elbow joint septic arthritis. Some of the conditions that can increase a person's risk of developing elbow joint septic arthritis, include
Elbow Joint Problems - Having a recent joint injury, particularly the elbow joint. An open wound, animal bites, cuts on the skin over the elbow joint, can increase the risk of infection, which can travel to the elbow joint via the bloodstream. A recent surgery of the elbow joint or if the elbow joint has a prosthesis or an implant in the elbow joint can increase the risk of elbow joint septic arthritis.
Elbow Joint Arthritis – Presence of arthritic conditions in the elbow joint. Certain types of arthritis like rheumatoid arthritis, gout or lupus affecting the elbow joint can increase its risk of getting infected. Sudden flare-ups of existing elbow arthritis can sometimes be due to worsening of the arthritis or the risk of elbow joint septic arthritis is always present.
Immune System Problems – Person having immune system disorders or a suppressed immune system are at an increased risk of developing elbow joint septic arthritis. Poor immune system can occur in those having AIDS, cancer, diabetes, immune disorders or those taking certain types of immunosuppressant medications or chemotherapy,
Infections – Presence of infections of the bone, e.g. osteomyelitis, near the elbow joint can increase the risk of developing elbow joint septic arthritis. Other infections like gonorrhea, a sexually transmitted disease, which can spread through the bloodstream, can increase the risk of elbow joint septic arthritis.
Others – Injecting street drugs or drug abuse, excess alcohol and smoking too can increase the risk of elbow joint septic arthritis. Certain skin conditions like psoriasis, eczema and similar skin disorders, in which the skin can break easily, giving an easy access to the microbes to enter into the bloodstream.
What are the Symptoms of Elbow Joint Septic Arthritis?
Elbow joint septic arthritis is an infective arthritis, in which the infective organism reaches the elbow joint and results in an inflammatory reaction. Hence, the symptoms begin suddenly and are often seen only in the affected joint, in this case, the elbow joint.
Some of the symptoms of elbow joint septic arthritis, include:
Sudden, severe pain in the elbow joint with fever and chills. The elbow joint is swollen, may appear red and feel warmth and tender on touch. The affected elbow joint is very painful, stiff and difficult to move. The range of motion of the elbow joint is affected and any movement causes severe pain. The person often feels weak and fatigued, with decreased appetite, malaise and sometimes increased irritability.
While elbow joint septic arthritis or infective arthritis of the elbow joint is mostly of a sudden onset, some underlying infections like tuberculosis can cause a gradual onset. Elbow joint septic arthritis in an artificial joint too can present with slow onset and gradual worsening of symptoms.
Redness, warmth and swelling in the elbow joint present a picture of elbow joint inflammation due to septic arthritis. The swelling is due to excess fluid accumulation in the joint space, which results from inflammation. However, this picture is seen in any condition causing elbow joint inflammation.
In order to differentiate elbow joint septic arthritis from others it is important to confirm the diagnosis and begin appropriate treatment at the earliest. Also, as elbow joint septic arthritis can sometimes cause some rapid changes in the joint and can even cause permanent joint damage, it is necessary to diagnose and initiate early treatment.
How is Elbow Joint Septic Arthritis Diagnosed?
Elbow joint septic arthritis mimics most of the other forms of arthritis and can be difficult to diagnose based on the clinical picture. However, proper history taking is done to understand the presence of risk factors, medical history, ongoing medications and pre-existing illnesses. Recent exposure to infections, surgery, skin or joint trauma, etc. are noted.
Clinical examination can reveal an inflamed elbow joint. Other signs of inflammation, degree of swelling, intensity of the elbow joint pain, presence of fever and other complaints are taken into account. Elbow joint functioning, range of motion and area around the elbow joint is assessed.
Sudden onset of joint inflammation, pain and swelling in elbow joint or any single joint can occur in various forms of arthritis, including gout in elbow and pseudogout in elbow. Hence, it is necessary to perform detailed investigations to confirm the diagnosis and plan appropriate treatment.
For confirmation of diagnosis, investigations are needed, which include
Blood Tests to Diagnose Elbow Joint Septic Arthritis
Elbow joint septic arthritis can be diagnosed with the help of blood tests, which can determine inflammation, presence of infection and will also help to rule out other forms of arthritis. Blood tests like CBC, ESR, CRP, are done to detect inflammation and understand its severity; to detect the possibility of septic or infective arthritis, or other forms of arthritis; detecting blood uric acids levels to rule out gout in elbow; RF, rheumatoid factor to rule out rheumatoid arthritis and other tests to rule out autoimmune disorders.
Additional tests to detect specific infections like tuberculosis, HIV, etc. may be done, if such infections are suspected based on the history of the person.
Imaging Studies to Diagnose Elbow Joint Septic Arthritis
Imaging studies like X-rays, CT scans and MRI can help to detect changes in the bone, joint deformities and damage occurring to other tissues. Damage to the cartilage and bony erosions can be detected through these imaging studies.
X-rays may be able to show minor changes in the elbow joint space due to the elbow joint swelling. X-rays also help to detect any injury to the elbow joint, condition of joint prosthesis, if any and other bony changes. MRI may help to detect effusion in elbow joint, changes in the elbow joint synovial membrane due to infection.
X-ray of the elbow joint can help to detect any presence of deposits in the cartilage, called chondrocalcinosis in the elbow joint, which is mostly due to calcium pyrophosphate crystal deposition in the elbow joint, seen in pseudogout in elbow. Ruling out the possibility of other forms of arthritis with similar presentation is important.
Performing these tests may be also useful in monitoring the progress of the disease and efficacy of the treatment plan, wherein damage to the joints and tissues needs to be studied.
Joint Fluid Analysis for Elbow Joint Septic Arthritis
Elbow joint septic arthritis causes sufficient amount of swelling around the elbow joint. The elbow becomes tender to touch, severely painful and becomes stiff. Joint fluid aspiration is performed as a diagnostic procedure to aspirate the excess fluid accumulated in the elbow joint. As no other tests can confirm the presence of septic arthritis in elbow, the only way is to find presence of microorganisms in the synovial fluid accumulated in the swollen elbow joint with joint fluid aspiration or arthrocentesis.
Joint fluid aspiration is a procedure performed taking aseptic precautions, in which a sterile needle is inserted into the elbow joint space around the swollen area. The excess synovial fluid accumulated in the swollen area, is aspirated through the needle. The aspirated fluid is sent for laboratory testing, where fluid analysis is done.
Joint fluid analysis and culture and sensitivity test help to confirm whether or not the fluid is infected, and if yes, which type of infection is present. The test helps to detect the presence of microorganisms, which can confirm the diagnosis of elbow joint septic arthritis. Inflammatory process in the elbow joint due to elbow joint septic arthritis also shows presence of other cells like white blood cells, pus cells, etc. which can aid in the diagnosis.
Any presence of uric acid crystals can direct towards the diagnosis of gout, presence of calcium pyrophosphate crystals towards pseudogout in elbow, while presence of specific microorganisms can confirm specific infections. Fluid analysis helps to detect the presence of pus cells, white blood cells, bacteria, which can help to detect many forms of arthritis including septic arthritis and tuberculosis.
What is the Treatment for Elbow Joint Septic Arthritis?
Elbow joint septic arthritis being an infective condition affecting the elbow joint, along with all measures to control the elbow joint pain and symptoms, proper medicines to treat the infective arthritis is the mainstay of the treatment for elbow joint septic arthritis.
Treatment of elbow joint septic arthritis includes administration of antibiotics to clear the infection. In most cases, if there is a strong suspicion of elbow joint septic or infective arthritis, anti-biotic treatment is immediately initiated, while other investigations are still going on to confirm the diagnosis and detect the infective microorganism. Intravenous administration of antibiotics is generally initiated and bed rest may be advised till the joint swelling subsides. Following, this and based on the test results, oral antibiotics along with anti-inflammatories may be given. Any specific infections may be treated appropriately, as required.
The culture and sensitivity tests performed on the drained synovial fluid from the elbow joint, may take 3 to 5 days to produce results. Based on the laboratory reports, the antibiotics and medicines to treat the infection may be modified to treat the specific infection. Treatment usually lasts from two to six weeks, depending on the severity of the elbow joint septic arthritis.
Pain Management for Elbow Joint Septic Arthritis
In acute attacks of elbow pain due to elbow joint septic arthritis, pain management aims at reducing the pain and swelling in the elbow joint. Resting the affected elbow joint is essential until the acute attack subsides and the infection is treated. Sometimes, light compression of the elbow joint can help in reducing the swelling and also allows the joint to rest, but care should be taken and not kept for too long, not too tight or not while sleeping. Splinting of the elbow joint is often done to protect the joint from pain during movement. Elevation of the joint and keeping the elbow joint raised above the heart level can help to reduce the swelling and pain of pseudogout in elbow.
Elbow Joint Aspiration for Elbow Joint Septic Arthritis
Joint aspiration or arthrocentesis for elbow joint septic arthritis is commonly performed when there is a huge swelling in the elbow joint that has affected the movement of the elbow. Stiffness and pain in the elbow joint is often unbearable and removing some excess accumulated fluid can help in relieving the pressure of the swollen elbow.
Aspiration of fluid from the elbow joint helps to relieve pain, pressure and reduces the swelling in the elbow joint, thus giving relief in symptoms. It also helps to improve the elbow joint movements and its functioning. In elbow joint septic arthritis, there is a risk that infection can cause damage to the elbow joint, hence fluid aspiration is done to remove the infected fluid. This can help to protect the elbow joint from damage, during which antibiotic treatment to treat the infection can be given.
Elbow Joint Arthroscopy for Elbow Joint Septic Arthritis
While joint fluid aspiration can be done using a syringe in arthrocentesis, sometimes joint arthroscopy of the elbow joint may be considered. Elbow joint septic arthritis, is an infective arthritic condition, which may take some time to confirm the diagnosis and presence of specific infection. In some severe cases, the joint fluid may be drained using an arthroscope, which is a small surgical procedure.
In elbow joint arthroscopy, small incisions are made around the affected elbow joint, through which a small tube with a tiny camera is inserted into the elbow joint. The surgeon is able to visualize the field inside the joint, based on which, the fluid is drained from the joint space. The joint area is irrigated and any infected tissue can be removed from the infected elbow joint.
In more severe cases, a drain or tube, which can help in further drainage of the infected fluid is left in place to prevent recurrence of swelling in the infected elbow joint. Repeated drainage of the elbow joint may be required till the infected fluid totally clears off. Meanwhile the course of antibiotics also helps to treat the infection, which helps in the recovery process.
Surgical Treatment for Elbow Joint Septic Arthritis
Most cases of elbow joint septic arthritis can be managed with arthrocentesis or arthroscopy of the elbow joint along with antibiotic treatment. However, in some cases, in which the infection has caused damage to the infected elbow joint or if the infection has occurred in an artificial elbow joint, surgical treatment options may be considered after the infection is treated with antibiotics.
Surgery for elbow joint septic arthritis may be performed to remove the damaged portions of the elbow joint, in order to protect the remaining elbow joint and maintain joint function. In some cases, joint replacement surgery may be performed to replace the damaged elbow joint with an artificial elbow joint.
Rehabilitation for Elbow Joint Septic Arthritis
After the treatment with antibiotics, anti-inflammatories and fluid drainage is done, rehabilitation of the elbow joint is essential with physical therapy. Physical therapy for elbow joint septic arthritis can help in regaining the elbow joint function and prevent long standing stiffness and pain in the affected elbow joint.
Physical therapy includes exercises for strengthening of muscles around the elbow joint, to improve flexibility of the elbow joint, minimize pain and prevent swelling. Any muscle wasting must be worked upon to regain the strength, weight training and gradual uptake of activities involving the elbow joint are planned.
What is the Prognosis or Outlook of Elbow Joint Septic Arthritis?
Elbow joint septic arthritis is a result of an infection in the body. If infected is suspected, properly diagnosed in time and promptly treated, there are greater chances of protecting the elbow joint and preventing any permanent damage.
Long term complications of untreated elbow joint septic arthritis can include permanent elbow joint pain, stiffness and inability to properly move the elbow joint. Delays in seeking medical advice can lead to progression of the infection, which can even cause permanent damage to the infected elbow joint. There are chances of the infection spreading to other parts of the body as well. In extreme cases, the infection can spread into the blood causing septicemia, which can sometimes even be fatal.
How to Prevent Elbow Joint Septic Arthritis?
Elbow joint septic arthritis has been noticed to be more common in presence of certain risk factors. Hence, people with joint problems, other types of arthritis, those suffering from rheumatoid arthritis and those who have an artificial elbow joint or a prosthesis in the elbow joint, can take certain precautions to prevent elbow joint septic arthritis.
Informing the treating physician about any recent episodes of infection, elbow joint injury or informing about the history of rheumatoid arthritis before any invasive procedures can help to plan an appropriate anti-biotic course for prevention and treatment.
- Knowing early signs and symptoms of septic arthritis in elbow joint can help in seeking prompt medical advice.
- Using proper hand washing techniques can help keep in infections at bay and preventing elbow joint septic arthritis.
- Protecting from insect bites, animal bites, while travelling is important to protect from infective arthritis.
- Avoiding drug abuse and taking necessary precautions when administering intravenous medicines can help.
- Practicing safe sex to prevent sexually transmitted disease is important to prevent elbow joint septic arthritis.
- Maintaining a healthy lifestyle, eating healthy meals and managing weight can reduce the risk of infections.