OBJECTIVES
       In 20 minutes we will cover the following:
       •   How to recognize the early signs of musculoskeletal 
           infections
       •   Review the initial evaluation of suspected bone and joint 
           infections
       •   Summarize the microbial causes of musculoskeletal 
           infections and their treatment
       CASE
       Friday afternoon: A 4 year old who had cough and runny nose for a 
       week, woke up with fever and refusing to stand. You start thinking 
       about the differential as you’re getting more details from the 
       history and physical exam:
       •   Toxic synovitis
       •   Osteomyelitis
       •   Septic arthritis
       •   Osteomyelitis and septic arthritis
       •   Pyomyositis
       •   Fracture
       •   Tumor
       •   Growing pain
        HISTORY
        -   Age and Sex
        -   Constitutional symptoms: Fever, weight loss, fatigue…
        -   Duration of symptoms
        -   Preceding trauma or illnesses
        -   Associated symptoms: Rash
        -   Sexual activity (Gonococcal arthritis)
        -   Immunization status (Haemophilus influenzae)
        -   History of hemoglobinopathies (Salmonella)
        -   Exposures: Animals, farms, travel to TB endemic areas… 
            (Bartonella henselae, Brucella, TB, Coccidioides)
        -   Past history of MRSA infection or contact
       EXAM
       -   Toxic appearance/High fever
       -   Gait: antalgic gait: Shorter stance on the affected limb to 
           avoid weight bearing
       -   Detailed musculoskeletal exam: Look for erythema, warmth, 
           swelling, tenderness
       -   Examine the back if the complaint is related to the lower 
           extremities
       -   Skin exam: look for cuts/abrasions as potential point of entry 
           of bacteria
       -   Abdominal exam: Appendicitis, Pyelonephritis
       -   Joint exam: Warm, swollen, erythematous joint. Except the 
           hip
     HIP EXAM
   -   comfortable position 
       more important than 
       the appearance of the 
       joint itself
   -   Flexed, abducted and 
       externally rotated