Arthrocentesis
Commonly used as an adjunctive treatment for orthopedic disorders such as joint trauma or septic arthritis, arthrocentesis involves insertion of a needle into the joint space to aspirate excessive synovial fluid or blood or to instill corticosteroids or other anti-inflammatory drugs. It also may be performed to obtain a specimen for diagnostic testing.
Most commonly performed on the knee, arthrocentesis also may be done on the elbow, shoulder, or other joints. It’s commonly combined with two related procedures: arthroscopy, which allows endoscopic visualization of the joint, and arthrography, an X-ray showing joint tissue and structure.
Procedure
After cleaning and sterilizing the area, the physician injects or sprays a local anesthetic
at the site. He then inserts the appropriate needle and aspirates at least 10 to 15 ml of synovial fluid from the joint. To aid aspiration, he may wrap an elastic bandage around the joint above and below the puncture site; this compresses the fluid into the site and ensures maximum aspiration.
at the site. He then inserts the appropriate needle and aspirates at least 10 to 15 ml of synovial fluid from the joint. To aid aspiration, he may wrap an elastic bandage around the joint above and below the puncture site; this compresses the fluid into the site and ensures maximum aspiration.
If the physician will be injecting medication into the joint space, he leaves the needle in the joint, detaches the fluid-filled syringe, attaches a drug-filled syringe, and injects the medication. After withdrawing the needle, he applies direct pressure over the puncture site for 2 minutes, then applies a sterile pressure dressing to control bleeding. If an excessive amount of fluid has been aspirated from the knee, an elastic bandage may be applied to improve joint stability and inhibit further fluid accumulation by compressing the joint space.
Complications
Arthrocentesis is performed under strict aseptic technique to avoid infecting the joint or contaminating the specimen. Other possible complications include intra-articular or soft-tissue hemorrhage, tendon rupture, and temporary nerve palsy.
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