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Upper extremity infection: imaging features with focus on magnetic resonance imaging

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Abstract

Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options.

Key findings

Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.

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Abbreviations

CT:

Computed tomography

US:

Ultrasound

MRI:

Magnetic resonance imaging

References

  1. Rigopoulos N, Dailiana ZH, Varitimidis S, Malizos KN. Closed-space hand infections: diagnostic and treatment considerations. Orthop Rev. 2012;4:2.

  2. Restrepo CS, Giménez CR, McCarthy K. Imaging of osteomyelitis and musculoskeletal soft tissue infections: current concepts. Rheum Dis Clin. 2003;29:89–109.

    Article  Google Scholar 

  3. Arnon SS, Schechter R, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001;285:1059–70.

    Article  CAS  PubMed  Google Scholar 

  4. Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders; 2009. p. 725–48.

    Chapter  Google Scholar 

  5. Kennedy N, Chambers ST, Nolan I, Gallagher K, Werno A, Browne M, et al. Native joint septic arthritis: epidemiology, clinical features, and microbiological causes in a New Zealand population. J Rheumatol. 2015;42:2392–7.

    Article  CAS  PubMed  Google Scholar 

  6. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis. 1999;58:214–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Maneiro JR, Souto A, Cervantes EC, Mera A, Carmona L, Gomez-Reino JJ. Predictors of treatment failure and mortality in native septic arthritis. Clin Rheumatol. 2015;34:1961–7.

    Article  PubMed  Google Scholar 

  8. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. 2002;15:527–44.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ferrand J, El Samad Y, Brunschweiler B, Grados F, Dehamchia-Rehailia N, Séjourne A, et al. Morbimortality in adult patients with septic arthritis: a three-year hospital-based study. BMC Infect Dis. 2016;16:1–10.

    Article  Google Scholar 

  10. Abdel MP, Perry KI, Morrey ME, Steinmann SP, Sperling JW, Cass JR. Arthroscopic management of native shoulder septic arthritis. J Shoulder Elbow Surg. 2013;22:418–21.

    Article  PubMed  Google Scholar 

  11. Kirchhoff C, Braunstein V, Buhmann S, Oedekoven T, Mutschler W, Biberthaler P. Stage-dependant management of septic arthritis of the shoulder in adults. Int Orthop. 2009;33:1015–24.

    Article  CAS  PubMed  Google Scholar 

  12. Lossos IS, Yossepowitch O, Kandel L, Yardeni D, Arber N. Septic arthritis of the glenohumeral joint: a report of 11 cases and review of the literature. Medicine. 1998;77:177–87.

    Article  CAS  PubMed  Google Scholar 

  13. Hunter JG, Gross JM, Dahl JD, Amsdell SL, Gorczyca JT. Risk factors for failure of a single surgical debridement in adults with acute septic arthritis. J Bone Joint Surg Am. 2015;97:558.

    Article  PubMed  Google Scholar 

  14. Pang H-N, Teoh L-C, Yam AKT, Lee JY-L, Puhaindran ME, Tan AB-H. Factors affecting the prognosis of pyogenic flexor tenosynovitis. JBJS. 2007;89:1742–8.

    Article  Google Scholar 

  15. Mehta P, Schnall SB, Zalavras CG. Septic arthritis of the shoulder, elbow, and wrist. Clin Orthop Related Res. 2006;1976–2007(451):42–5.

    Article  Google Scholar 

  16. Lipsky BA, Aragón-Sánchez J, Diggle M, Embil J, Kono S, Lavery L, et al. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016;32:45–74.

    Article  PubMed  Google Scholar 

  17. Sussmann AR, Cohen J, Nomikos GC, Schweitzer ME. Magnetic resonance imaging of shoulder arthropathies. Magn Reson Imaging Clin. 2012;20:349–71.

    Article  Google Scholar 

  18. Jbara M, Patnana M, Kazmi F, Beltran J. MR imaging: arthropathies and infectious conditions of the elbow, wrist, and hand. Radiologic Clinics. 2006;44:625–42.

    PubMed  Google Scholar 

  19. Stutz G, Kuster MS, Kleinstück F, Gächter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc. 2000;8:270–4.

    Article  CAS  PubMed  Google Scholar 

  20. Qiu B, Al K, Pena-Diaz AM, Athwal GS, Drosdowech D, Faber KJ, et al. Cutibacterium acnes and the shoulder microbiome. J Shoulder Elbow Surg. 2018;27:1734–9.

    Article  PubMed  Google Scholar 

  21. Holmes S, Diaz AMP, Athwal GS, Faber KJ, O’Gorman DB. Neer Award 2017: a rapid method for detecting Propionibacterium acnes in surgical biopsy specimens from the shoulder. J Shoulder Elbow Surg. 2017;26:179–85.

    Article  PubMed  Google Scholar 

  22. Tang JS, Gold RH, Bassett LW, Seeger LL. Musculoskeletal infection of the extremities: evaluation with MR imaging. Radiology. 1988;166:205–9.

    Article  CAS  PubMed  Google Scholar 

  23. Aïm F, Delambre J, Bauer T, Hardy P. Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthop Traumatol Surg Res. 2015;101:61–4.

    Article  PubMed  Google Scholar 

  24. Jeon I-H, Choi C-H, Seo J-S, Seo K-J, Ko S-H, Park J-Y. Arthroscopic management of septic arthritis of the shoulder joint. JBJS. 2006;88:1802–6.

    Google Scholar 

  25. Lew DP, Waldvogel FA. Osteomyelitis. The Lancet. 2004;364:369–79.

    Article  CAS  Google Scholar 

  26. Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. JBJS. 2004;86:2305–18.

    Article  Google Scholar 

  27. Santos JMM. Diagnostic imaging of pediatric hematogenous osteomyelitis: lessons learned from a multi-modality approach. Eur Radiol. 2006;16:2109–19.

    Article  Google Scholar 

  28. Marui T, Yamamoto T, Akisue T, Nakatani T, Hitora T, Nagira K, et al. Subacute osteomyelitis of long bones. Clin Imaging. 2002;26:314–8.

    Article  PubMed  Google Scholar 

  29. Weishaupt D, Schweitzer ME. MR imaging of septic arthritis and rheumatoid arthritis of the shoulder. Magn Reson Imaging Clin. 2004;12:111–24.

    Article  Google Scholar 

  30. Duncan SFM, Sperling JW. Treatment of primary isolated shoulder sepsis in the adult patient. Clin Orthop Relat Res. 2008;466:1392–6.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wilson DJ. Soft tissue and joint infection. Eur Radiol Suppl. 2004;14:E64-71.

    Article  Google Scholar 

  32. Klinger H-M, Baums MH, Freche S, Nusselt T, Spahn G, Steckel H. Septic arthritis of the shoulder joint: an analysis of management and outcome. Acta Orthop Belg. 2010;76:598.

    PubMed  Google Scholar 

  33. Boutin RD, Brossmann J, Sartoris DJ, Reilly D, Resnick D. Update on imaging of orthopedic infections. Orthop Clin North Am. 1998;29:41–66.

    Article  CAS  PubMed  Google Scholar 

  34. Leslie BM, Harris JM 3rd, Driscoll D. Septic arthritis of the shoulder in adults. JBJS. 1989;71:1516–22.

    Article  CAS  Google Scholar 

  35. Leslie BM, Harris 3rd JM, Driscoll D. Septic arthritis of the shoulder in adults. JBJS. 1989;71:1516–1522.

  36. Schweitzer M, Morrison WB. Arthropathies and inflammatory conditions of the elbow. Magn Reson Imaging Clin N Am. 1997;5:603–17.

    Article  CAS  PubMed  Google Scholar 

  37. Rausch V, von Glinski A, Rosteius T, Königshausen M, Schildhauer TA, Seybold D, et al. Secondary purulent infections of the elbow joint: a retrospective, single-center study. BMC Musculoskelet Disord. 2020;21:1–7.

    Article  Google Scholar 

  38. Matsumura N, Oguro S, Okuda S, Jinzaki M, Matsumoto M, Nakamura M, et al. Quantitative assessment of fatty infiltration and muscle volume of the rotator cuff muscles using 3-dimensional 2-point Dixon magnetic resonance imaging. J Shoulder Elbow Surg. 2017;26:e309–18.

    Article  PubMed  Google Scholar 

  39. Blackwell JR, Hay BA, Bolt AM, Hay SM. Olecranon bursitis: a systematic overview. Shoulder Elbow. 2014;6:182–90.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lombardi A, Ashir A, Gorbachova T, Taljanovic M, Chang EY. Magnetic resonance imaging of the elbow. Pol J Radiol. 2020;85:440–60.

    Article  Google Scholar 

  41. Heye S, Matthijs P, Wallon J, Van Campenhoudt M. Cat-scratch disease osteomyelitis. Skeletal Radiol. 2003;32:49–51.

    Article  CAS  PubMed  Google Scholar 

  42. Bernard SA, Walker EA, Carroll JF, Klassen-Fischer M, Murphey MD. Epitrochlear cat scratch disease: unique imaging features allowing differentiation from other soft tissue masses of the medial arm. Skeletal Radiol. 2016;45:1227–34.

    Article  PubMed  Google Scholar 

  43. Beltrame A, Barabino G, Cicciò C, Monteiro GB, Cavalchini A, Carbognin G, et al. Magnetic resonance imaging in pure neural leprosy. Int J Infect Dis. 2017;60:42–3.

    Article  PubMed  Google Scholar 

  44. Martinoli C, Derchi LE, Bertolotto M, Gandolfo N, Bianchi S, Fiallo P, et al. US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol. 2000;29:142–50.

    Article  CAS  PubMed  Google Scholar 

  45. Patel DB, Emmanuel NB, Stevanovic MV, Matcuk GR Jr, Gottsegen CJ, Forrester DM, et al. Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options. Radiographics. 2014;34:1968–86.

    Article  PubMed  Google Scholar 

  46. Martinoli C, Derchi LE, Bertolotto M, Gandolfo N, Bianchi S, Fiallo P, Nunzi E. US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol. 2000;29:142–50.

  47. Schmidt G, Piponov H, Chuang D, Gonzalez M. Hand infections in the immunocompromised patient: an update. J Hand Surg Am. 2019;44:144–9.

    Article  PubMed  Google Scholar 

  48. Francel TJ, Marshall KA, Savage RC. Hand infections in the diabetic and the diabetic renal transplant recipient. Ann Plast Surg. 1990;24:304–9.

    Article  CAS  PubMed  Google Scholar 

  49. Schnall SB, Vu-Rose T, Holtom PD, Doyle B, Stevanovic M, Connor RW, et al. Tendon sheath patterns in the hand; an anatomical study based on 367 hand dissections. Hand Clin. 1998;14:315–9.

    Google Scholar 

  50. Houshian S, Seyedipour S, Wedderkopp N. Epidemiology of bacterial hand infections. Int J Infect Dis. 2006;10:315–9.

    Article  PubMed  Google Scholar 

  51. Ew S. Tendon sheath patterns in the hand; an anatomical study based on 367 hand dissections. Surg Gynecol Obstet. 1951;93:16–22.

    Google Scholar 

  52. Jebson PJ. Infections of the fingertip. Paronychias Felons Hand Clin. 1998;14:547–55.

    Article  CAS  PubMed  Google Scholar 

  53. Doyle JR. Anatomy of the flexor tendon sheath and pulley system: a current review. J Hand Surg Am. 1989;14:349–51.

    Article  CAS  PubMed  Google Scholar 

  54. Fussey JM, Chin KF, Gogi N, Gella S, Deshmukh SC. An anatomic study of flexor tendon sheaths: a cadaveric study. J Hand Surg (Eur Vol). 2009;34:762–5.

    Article  CAS  PubMed  Google Scholar 

  55. Schnall SB, Vu-Rose T, Holtom PD, Doyle B, Stevanovic M. Tissue pressures in pyogenic flexor tenosynovitis of the finger: compartment syndrome and its management. J Bone Joint Surg Br. 1996;78:793–5.

    Article  CAS  PubMed  Google Scholar 

  56. Jennings JD, Ilyas AM. Septic arthritis of the wrist. JAAOS-J Am Acad Orthopaedic Surg. 2018;26:109–15.

    Article  Google Scholar 

  57. Laohawiriyakamol T, Tanutit P, Kanjanapradit K, Hongsakul K, Ehara S. The, “dot-in-circle” sign in musculoskeletal mycetoma on magnetic resonance imaging and ultrasonography. Springerplus. 2014;3:1–7.

    Article  Google Scholar 

  58. Basirat A, Boothe E, Mazal AT, Mansoori B, Chalian M. Soft tissue mycetoma: “Dot-in-circle” sign on magnetic resonance imaging. Radiol Case Rep. 2020;15:467–73.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Shapiro DB. Postoperative infection in hand surgery: cause, prevention, and treatment. Hand Clin. 1998;14:669–81.

    Article  CAS  PubMed  Google Scholar 

  60. Kumar Y, Khaleel M, Boothe E, Awdeh H, Wadhwa V, Chhabra A. Role of diffusion weighted imaging in musculoskeletal infections: current perspectives. Eur Radiol. 2017;27:414–23.

    Article  PubMed  Google Scholar 

  61. Guirguis M, Sharan G, Wang J, Chhabra A. Diffusion-weighted MR imaging of musculoskeletal tissues: incremental role over conventional MR imaging in bone, soft tissue, and nerve lesions. BJR Open. 2022;4:20210077.

    PubMed  PubMed Central  Google Scholar 

  62. Pezeshk P, Alian A, Chhabra A. Role of chemical shift and Dixon based techniques in musculoskeletal MR imaging. Eur J Radiol. 2017;94:93–100.

    Article  PubMed  Google Scholar 

  63. Alaia EF, Chhabra A, Simpfendorfer CS, Chen M, et al. MRI nomenclature for musculoskeletal infection. Skeletal Radiol. 2021;50:2319–47.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Palmer W, Bancroft L. Bonar f, Choi JA Glossary of terms for musculoskeletal radiology. Skeletal Radiol. 2020;49:S1–33.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil

    Tatiane Cantarelli Rodrigues, Abdalla Skaf & Ivan Rodrigues Barros Godoy

  2. ALTA Diagnostic Center (DASA Group), São Paulo, Brazil

    Tatiane Cantarelli Rodrigues, Abdalla Skaf & Ivan Rodrigues Barros Godoy

  3. Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Atul Kumar Taneja

  4. Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil

    Ivan Rodrigues Barros Godoy

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  1. Tatiane Cantarelli Rodrigues
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Contributions

Tatiane Cantarelli Rodrigues: The author organized the data included, edited the figures in the text and wrote and edited the manuscript draft.

Atul Kumar Taneja: The author revised it critically and approved the modified text and contributed with cases for the review.

Abdalla Skaf: The author revised it critically and approved the modified text and contributed with cases for the review.

Ivan Rodrigues Barros Godoy: The author wrote the manuscript draft and edited the final reviewed version.

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Correspondence to Ivan Rodrigues Barros Godoy.

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Rodrigues, T.C., Taneja, A.K., Skaf, A. et al. Upper extremity infection: imaging features with focus on magnetic resonance imaging. Skeletal Radiol (2023). https://doi.org/10.1007/s00256-023-04545-8

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