Arthrocentesis

• an intervention that can be both diagnostic and therapeutic.
  
• It has been called a “liquidbiopsy of the joint.”
  
• It is absolutely essential when considering the diagnosis of a septic joint and can guide therapy in crystalline diseases.
  
• Steroid injections may improve quality of life by suppressing pain and inflammation, increasing function and making exercise regimens possible.
  
• In many instances, injection and aspiration can be done by primary physicians.
  
• It is absolutely essential to understand the anatomy of the area you want to inject to avoid major neurovascular structures.

INDICATIONS

1. Diagnostic

• a. Infectious arthritis
• b. Crystals (gout, CPPD, others)
• c. confirmation of diagnosis

i) Suspected soft tissue problems (i.e. epicondylitis) can be confirmed when symptoms improve after injection with local anesthetic

ii) Suspected inflammatory arthritis can be confirmed (and infection ruled out)

d. Others

i) Hemorrhage (coagulation disorders, trauma, etc)

ii) PVNS

iii) Ochronosis

2. Therapeutic

A. Pain relief (both articular and nonarticular) when conservative measures
have failed
B. reduction of intra - articular pressure
C. removal of damaging purulent fluid
D. installation of medication (steroids)

• Cellulitis of skin overlying joint
  
• Bleeding diathesis
  
• Bacteremia
  
• Corticosteroids into a septic or fractured joint
  
• Difficult anatomy
  
• Diabetes (corticosteroid may worsen serum glucose)
  
• Pre-existing tendon injury may be a contraindication to injecting that tendon

Category: Orthopedics Notes