Joint aspiration or injection in adults: Technique and indications
- W Neal Roberts, Jr, MD
W Neal Roberts, Jr, MD
- Chief of Rheumatology
- University of Lousiville
- Section Editor
- Daniel E Furst, MD
Daniel E Furst, MD
- Section Editor — Treatment Issues in Rheumatology
- Clinical professor, University of Washington, Seattle
- Clinical professor, University of Florence, Florence, Italy
- Professor of Rheumatology, University of California in Los Angeles (Emeritus)
- Director of Research, Pacific Arthritis Associates
A needle is inserted into a joint for two main indications: aspiration of fluid (arthrocentesis) for diagnosis or for relief of pressure, or injection of medications. In practical terms, most injections into joints consist of a glucocorticoid, a local anesthetic, or a combination of the two. Occasionally saline is injected into the joint to diagnose a joint injury.
This topic will review the basic technique of inserting a needle into a joint and the main indications for intraarticular steroid injections. The same techniques apply for injection of the less commonly used hyaluronate viscosupplementation agents into knees, hips, and perhaps shoulders.
The choice of injectable glucocorticoid and whether it should be combined with a local anesthetic, the frequency of injection, and potential complications that can occur are discussed separately (see "Intraarticular and soft tissue injections: What agent(s) to inject and how frequently?" and "Joint aspiration or injection in adults: Complications"). The injection of saline (ie, saline load test), used to diagnose traumatic arthrotomy, is also discussed elsewhere. (See "Severe extremity injury in the adult patient", section on 'Soft tissue and bone assessment'.)
INDICATIONS FOR ASPIRATION OR INJECTION
There are a number of indications, both diagnostic and therapeutic, for joint aspiration or injection (table 1). Arthrocentesis and synovial fluid analysis are important in the evaluation of a patient who has an effusion or signs suggesting inflammation within the joint. (See "Overview of monoarthritis in adults".)
The two most important indications for diagnosis are:
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- INDICATIONS FOR ASPIRATION OR INJECTION
- PATIENT EDUCATION
- TECHNIQUE OF ARTHROCENTESIS
- Needle size
- Syringe size
- Removing hair at the aspiration site
- Sterile preparation
- - Skin preparation
- - Single versus multidose medication vials
- Local anesthesia
- Switching syringes
- Approach to the patient on anticoagulants
- ANATOMIC APPROACHES TO SPECIFIC JOINTS AND BURSAE
- Elbow (lateral epicondyle)
- Subacromial bursa
- Trochanteric bursa
- Sternoclavicular joint
- Hip aspiration
- DIFFICULT SITES TO ACCESS
- Dry taps
- SUMMARY AND RECOMMENDATIONS