Examination of a child with a joint infection

What is it about ?

Arthritis is inflammation in a joint. The main features of inflammation are: swelling, redness, heat, pain, and limitation of movement.

There are many causes that can cause a joint infection. We distinguish between traumatic and non-traumatic forms. Traumatic forms are always due to an accident (for example a sports accident).

Non-traumatic forms can be divided between cases due to infection and those not due to infection. With infectious arthritis (therefore due to infection), a virus or bacteria is present in the joint. The forms that are not due to infection are by far the most common. Conditions like rheumatism and the drop are part of. Sometimes arthritis is part of an underlying condition such as psoriasis and the chronic inflammatory bowel disease.

How to recognize them?

In infectious arthritis, there is usually a rash, sometimes also accompanied by fever. Often in arthritis due to a rheumatic condition (without infection), pain is not the main symptom. On the other hand, stiffness after a period of rest is a very characteristic sign of inflammation. Pain after physical activity is more common with joint damage without inflammation, for example after a fall.

Arthritis in children can often be easily located thanks to the description of the symptoms by the parents:

• one of the large joints of the lower extremities if the child does not want to get out of bed anymore, but wants to be taken out;
• the knee or hip if the child has a bent knee;
• the wrists if the child stands on his knuckles, his fists clenched when he crawls instead of moving forward on the palms of the hands;
• the neck if the child does not turn his head but the entire upper body when looking to the side.

How is the diagnosis made?

The doctor will check if the child is walking and running normally or if he is limping. He will check all the joints to see if there is any swelling, redness or changes in temperature. He will also examine whether there is fluid in the joint, especially in the knee, and he will test the mobility of the different joints.

The doctor will proceed systematically, and he will try to move all the joints as far as possible around the different axes (bends, extensions, rotations and lateral movements). If mobility is normal, he checks to see if there is a difference in muscle mass between the child’s right and left flanks.

Source

Foreign clinical practice guide ‘Joint examination of a child with signs of arthritis’ (2000), updated on 19.01.2017 and adapted to the Belgian context on 02.11.2019 – ebpracticenet