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Arthrocentesis
all information

Arthrocentesis

(Closed Joint Aspiration)

En Español (Spanish Version)

Definition

Puncture of a joint space with a sterile needle to do either of the following:

  • Withdraw fluid for diagnosis and/or treatment of a condition
  • Inject medications into the joint space

Arthrocentesis

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Parts of the Body Involved

Any joint in the body, but usually larger ones such as the knee, shoulder, etc.

Reasons for Procedure

  • Diagnose and/or treat a painful, swollen, fluid-filled joint
  • Diagnose the specific type of arthritis occurring within a joint
  • Verify the presence of an infection, identify the causative agent, and follow the progress of antibiotic therapy
  • Check for crystals in the joint fluid, which could be a sign of gout
  • Inject medications into the joint space, such as an anesthetic or an anti-inflammatory agent (eg, cortisone)

Risk Factors for Complications During the Procedure

  • Infections or abrasions of adjacent skin
  • Recent fevers or infections anywhere in the body
  • Pre-existing bleeding disorder
  • Use of blood thinners (anticoagulants), with poorly controlled blood levels
  • You should tell your doctor if you take anti-inflammatory medications, as they can sometimes affect bleeding
  • Allergic reaction to local anesthetic, other injected medications, topical cleansing solutions, or latex

What to Expect

Prior to Procedure

Your doctor will likely do some or all of the following:

  • Examine your joint
  • X-rays
  • MRI scan—a test that uses a strong magnetic field and radio waves to make pictures of the inside of the joint

During Procedure

Anesthesia is possible, depending on the joint.

Anesthesia

Local anesthetic is typically used to numb the specific area involved. Usually, no sedation is required in adults.

Description of the Procedure

Your doctor will use an antiseptic solution to clean the area of the joint where the needle will be inserted. You may receive an injection of a local anesthetic to numb the area. The arthrocentesis needle is inserted into the fluid-filled joint cavity. Medicine is injected in or fluid is removed.

When a sufficient sample of fluid has been drawn for diagnosis, an appropriate amount of fluid has been drained, or the medicine delivered the needle is removed. Pressure is put on the area where the needle entered the joint, and a small bandage may be placed over the puncture. A compression bandage may be applied to help prevent reaccumulation of joint fluid.

After Procedure

Fluid samples will be examined by a laboratory.

How Long Will It Take?

The procedure should take about 5 to 10 minutes after the setup is complete.

Will It Hurt?

If local anesthetic is given, there will be some stinging or burning during the injection. Without local anesthetic, there is some pain during insertion of the needle into the skin and into the joint space, and you may feel a popping sensation as the needle enters the joint space.

Possible Complications

  • Infection of the joint
  • Bleeding into the joint
  • Allergic reaction
  • Exacerbation of pain

Note that fluid may recur within the joint; this is not a complication, but indicative of the joint problem. If medications are injected, you should ask your doctor about specific complications.

Average Hospital Stay

There is usually no hospital stay associated with this procedure.

Postoperative Care

  • You can go home soon after the procedure is completed.
  • You may be advised to ice the joint every 3 to 4 hours, for 20 minutes at a time, for 24 hours following the procedure.
  • You may be advised to take acetaminophen, ibuprofen, or some other relatively mild pain killer for a day or two after the procedure.
  • Your doctor will tell you whether you may immediately resume normal activity, or whether you should have some period of restricted activity. The latter is more common.

Outcome

If arthrocentesis is done as a diagnostic test, the laboratory report on the fluid may reveal the reason for your joint inflammation.

If arthrocentesis is done to drain accumulated fluid, pain will diminish and more motion will result. However, you may have a recurrence of the joint fluid depending upon the reason for the initial fluid buildup. The doctor will carefully monitor your progress.

If anti-inflammatory medications are injected into the joint, they may help to decrease inflammation and pain within the joint. Over time, these effects may wear off and you may require further treatment.

Call Your Doctor If Any of the Following Occurs

  • Signs of local infection, which include fever, chills, plus skin redness, increasing pain, and swelling
  • Excessive bleeding or discharge at the site of the arthrocentesis

RESOURCES:

Arthritis Foundation
http://www.arthritis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
http://www.niams.nih.gov

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org/

The Arthritis Society
http://www.arthritis.ca

References:

Clinical Procedures in Emergency Medicine . 3rd ed. Philadelphia, PA: W.B. Saunders Co.; 1998.

Emergency Medicine: Concepts and Clinical Practice . 4th ed. Philadelphia, PA: Mosby-Year Book; 1998.

National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov . Accessed October 14, 2005.



Last reviewed December 2007 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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