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Review Question - QID 7814

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QID 7814 (Type "7814" in App Search)
A 25-year-old man has a swollen painful sternoclavicular joint. He denies using drugs or having any other medical conditions. Examination does not reveal any evidence of a dislocation. The joint is tender and slightly warm. The chest radiograph is normal. What is the next most appropriate step in management?

CT of the chest

54%

591/1090

Bone scan

10%

113/1090

Irrigation and debridement in the operating room

28%

304/1090

Lidocaine injection of the joint

3%

37/1090

Physical therapy

3%

31/1090

Select Answer to see Preferred Response

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A common cause of a septic sternoclavicular (SC) joint is IV drug use. Recently, however, there have been case reports of septic SC joints in patients without a history of drug use; therefore, this history should not be used as a predictor of severity or extension beyond the SC joint capsule. Because of the risk of extension of the infection to the retrosternal area and pericardium, it is recommended that a CT scan be obtained before proceeding with any surgical management. A bone scan cannot accurately show abscess extension into the retrosternal area. Lidocaine injection and physical therapy should not be considered until infection is ruled out.

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