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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.
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Management and Disposition
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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.
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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.