Question

a patient experiencing shoulder pain is seen by an orthopedic specialist who notes erythema, warmth, and fluctuance of the shoulder joint. what is the next step in treatment for this patient?

admit to the hospital for intravenous antibiotics

inject lidocaine into the joint and reassess in 5 to 10 minutes.

order a plain radiograph of the shoulder to identify possible fracture.

perform a shoulder ultrasound to further evaluate the cause.

Explanation:

The patient has signs (erythema, warmth, fluctuance) suggestive of septic arthritis. Septic arthritis is a medical emergency. Intravenous antibiotics are crucial as prompt treatment with appropriate antibiotics (given intravenously initially to achieve high blood levels) is needed to prevent joint destruction. Lidocaine injection (for pain relief assessment) is not the priority in a likely infectious process. A plain radiograph may not show early signs of septic arthritis (like joint effusion clearly in some cases) compared to ultrasound in some aspects, but the main issue is starting treatment for infection. However, the key is that for a likely septic joint (infection), admission for IV antibiotics is the immediate next - step as it addresses the life - and - joint - threatening infection.

Answer:

Admit to the hospital for intravenous antibiotics.