Welcome to emergency medicine cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

Our guest experts on this month's episode number 16, Hot Joint's What to Do, are Dr. Joel

Yaffe and Dr. Indy Goche. Dr. Yaffey is an emergency physician at the University Health

Network in Toronto. He's assistant director of education at the Department of Emergency Medicine

at UHN and an assistant professor of medicine at the University of Toronto. He's the director

of the University of Toronto's annual update in Emergency Medicine

Conference in Wester, B.C. Dr. Andy Gosh is an emergency physician as well as the chief and

clinical director of emergency medicine at York Central Hospital in Toronto. He was the program

director for the CCFPEM residency program and the Division of Emergency Medicine at McMaster

University in Hamilton, Ontario. When we pick up a chart in the ED of a patient with the chief complaint of a painful swollen

joint, we generally don't jump up and down with excitement, partly because the tests available

to us in the ED are rarely able to help us make a definitive diagnosis, and partly because

of our perception that patients with acute monoarthritis are unlikely to have

life-threatening diagnoses.

Here's the problem.

There's three major diagnostic considerations in adult acute monoarthritis, septic arthritis,

septic arthritis, crystal arthritis, and occult trauma.

And there's considerable overlap in their clinical presentations. And you can have two of

these diagnoses at the same time. All of these can present with fever, painful passive range

of motion, non-weight bearing, and have a hot swollen joint. Based on history and physical

examination and even after lab testing, it's not always possible

to differentiate these entities.

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