Our Summary

This research paper aims to provide guidelines for the management of small joint septic arthritis (SJSA) of the hand, an area not adequately covered by current guidance which is more focused on large joints. The researchers conducted a review of previous studies and surveyed members of the British Society for Surgery of the Hand to gather expert opinion.

The findings suggest that the recommended treatment for this condition includes removing the infected fluid from the joint, washing it out, and starting early antibiotic treatment. This should be followed by exercises guided by a physiotherapist to help the joint move again.

The diagnosis of SJSA was found to be most often made through a medical history and examination, blood tests, drawing fluid from the joint for testing, and monitoring the patient’s vital signs. The preferred interventions were elevating the joint, administering intravenous antibiotics, and washing out the joint again within 48 hours if necessary.

The authors note that diagnosing an infection in small joints is trickier than in large joints because it’s harder to draw fluid from them without causing damage. Therefore, they recommend using blood tests and medical imaging, along with the patient’s symptoms, to diagnose the problem and start treatment and rehabilitation as soon as possible.

FAQs

  1. What is the recommended treatment for small joint septic arthritis (SJSA) of the hand?
  2. How is the diagnosis of SJSA typically made according to the research?
  3. Why is diagnosing an infection in small joints more difficult than in large joints?

Doctor’s Tip

Overall, the key takeaway for patients undergoing hand surgery is to follow post-operative care instructions carefully, attend all follow-up appointments, and participate actively in rehabilitation exercises prescribed by the healthcare team. This will help ensure a successful recovery and optimal outcome for the hand surgery.

Suitable For

Patients who are typically recommended for hand surgery include those with conditions such as:

  1. Traumatic injuries: Patients who have suffered from fractures, dislocations, tendon injuries, nerve injuries, or ligament injuries in the hand may require hand surgery to restore function and alleviate pain.

  2. Arthritis: Patients with arthritis in the hand, including osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis, may benefit from hand surgery to improve joint function and reduce pain.

  3. Tumors: Patients with benign or malignant tumors in the hand may require surgery to remove the tumor and prevent further spread.

  4. Congenital abnormalities: Patients born with hand deformities or congenital abnormalities such as syndactyly (webbed fingers) or polydactyly (extra fingers) may benefit from hand surgery to improve function and appearance.

  5. Nerve compression syndromes: Patients with conditions such as carpal tunnel syndrome or cubital tunnel syndrome, which result in nerve compression and symptoms such as numbness, tingling, or weakness in the hand, may require surgery to release the compressed nerve.

  6. Dupuytren’s contracture: Patients with Dupuytren’s contracture, a condition characterized by thickening and tightening of the tissue in the palm of the hand, may require surgery to release the contracture and improve hand function.

Overall, patients who have persistent pain, loss of function, or deformity in the hand that significantly impacts their quality of life may be recommended for hand surgery. It is important for patients to consult with a hand surgeon to determine the most appropriate treatment plan for their specific condition.

Timeline

Before hand surgery, a patient may experience pain, swelling, redness, and limited range of motion in the affected joint. They may also undergo various diagnostic tests such as blood tests, imaging studies, and joint fluid analysis to determine the cause of their symptoms.

After hand surgery, the patient may experience some discomfort and swelling at the surgical site. They will need to follow post-operative instructions provided by their healthcare provider, which may include wearing a splint or cast, performing exercises to improve range of motion, and attending follow-up appointments.

Recovery time can vary depending on the type of surgery performed and the individual patient’s healing process. Physical therapy may be recommended to help regain strength and function in the hand. In some cases, full recovery may take several weeks to months.

Overall, the goal of hand surgery is to improve the patient’s quality of life by reducing pain, restoring function, and preventing further damage to the affected joint. With proper diagnosis, treatment, and rehabilitation, patients can achieve successful outcomes and return to their normal activities.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hand surgery for small joint septic arthritis include:

  1. What is the specific diagnosis for my condition and how did you determine it?
  2. What are the treatment options available for small joint septic arthritis in the hand?
  3. What is the recommended treatment plan for my specific case?
  4. What are the potential risks and complications associated with the surgery?
  5. How long is the recovery process expected to take?
  6. Will I require any follow-up appointments or additional therapy after the surgery?
  7. Are there any alternative treatments or therapies that I should consider?
  8. How will the surgery impact my daily activities and hand function?
  9. What can I do to help optimize my recovery and improve outcomes after the surgery?
  10. Are there any specific restrictions or precautions I should be aware of during the recovery period?

Reference

Authors: Adeboye T, Giwa L, Jemec B. Journal: J Hand Surg Asian Pac Vol. 2023 Oct;28(5):530-538. doi: 10.1142/S2424835523500650. Epub 2023 Oct 27. PMID: 37905368