Arthocentesis

Arthocentesis. Procedure where fluid is removed from a joint space or medication may be administered into the joint cavity for diagnostic or therapeutic purposes.

INDICATIONS:

• To evaluate synovial fluid and determine whether the cause of effusion is from infectious, rheumatic, traumatic, or crystal-induced etiology
• To remove exudative fluid from a septic joint
• To relieve pain in a grossly swollen joint (e.g., traumatic effusion)
• To inject lidocaine, saline, or corticosteroids into acutely inflamed trigger points or tender joints

CONTRAINDICATIONS:

• Cellulitis or broken skin over the intended entry site for the injection or aspiration
• Anticogulant therapy that is not well controlled
• Septic effusion of a bursa or a periarticular structure (for injection)
• Lack of response to two or three prior injections
• Suspected bacteremia (unless the joint is suspected as the source of the bacteremia , it should not be tapped.
• Doing so could inoculate the joint space and actually cause infection)
• Joint prostheses (If infection is suspected, consider a referral to the orthopedist who placed the prosthesis, if at all possible)

PRE- and POST-PROCEDURE PATIENT EDUCATION:

Inform the patient of the risks, benefits, and possible complications of injection therapy. This is especially important if steroids are used. Rarely is there ever complication from the use of lidocaine alone. Inform the patient that there is always a possibility for infection from the injection, although this is extremely rare. Bleeding into a joint can occur, although this generally does not happen unless the patient has a coagulopathy. The injection may actually cause more pain during the first 24 to 36 hours. This is called steroid flare. If the pain last for more than 36 hours, evaluate the patient for the possibility of septic joint.

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