Joint aspiration or injection in children: Indications, technique, and complications
- Thomas JA Lehman, MD
Thomas JA Lehman, MD
- Section Editor — Pediatric Rheumatology
- Professor of Clinical Pediatrics
- Cornell University Medical College
Joint aspiration and injections are used for diagnostic and therapeutic purposes in the care of children with arthritis.
The indications and complications of intra-articular aspiration and injection in children are reviewed here. Details regarding the medications used and the benefits of this procedure for specific conditions are discussed separately. (See "Oligoarticular juvenile idiopathic arthritis", section on 'Initial therapy' and "Polyarticular juvenile idiopathic arthritis: Treatment", section on 'Intra-articular glucocorticoids'.)
The primary reason for joint aspiration is to assist in the diagnosis of inflamed joints (ie, arthritis), especially to determine whether infection is the cause of inflammation. Therapeutic injection generally involves the administration of glucocorticoids to suppress joint inflammation.
Diagnostic indications — In children with arthritis, joint aspiration is most often performed to differentiate bacterial (septic) arthritis from other inflammatory conditions. Empiric antibiotic therapy is administered promptly after aspiration in all patients with signs and symptoms suggestive of septic arthritis until culture results are available. Continuation of empiric antibiotic therapy is mandatory until culture results are available if bacteria are detected by microscopic examination of the synovial fluid. (See "Bacterial arthritis: Clinical features and diagnosis in infants and children" and "Bacterial arthritis: Treatment and outcome in infants and children", section on 'Empiric parenteral therapy'.)
Arthrocentesis is of limited diagnostic value in children whose joint inflammation is not thought to be infectious in origin, with the exception that grossly bloody fluid suggests pigmented villonodular synovitis. The varied forms of noninfectious childhood arthritis are usually not reliably distinguished from one another based upon joint fluid analysis. For example, the diagnosis of the different forms of juvenile idiopathic arthritis (JIA) is based upon clinical parameters, although children with documented JIA may subsequently develop infection in a concurrently arthritic joint and thereby require joint aspiration. In addition, gout and other crystal-induced inflammatory conditions, in which diagnostic arthrocentesis is helpful, are extremely rare in children and adolescents. Other mechanical/orthopedic causes should be investigated if the fluid is noninfectious and the white blood cell count is normal. (See "Oligoarticular juvenile idiopathic arthritis", section on 'Differential diagnosis' and "Evaluation of the child with joint pain and/or swelling", section on 'Differential diagnosis'.)
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- Diagnostic indications
- Therapeutic indications
- - Joint aspiration
- - Joint injections
- Needle and syringe size
- Sterile preparation
- Anatomic approaches
- Synovial fluid collection
- Additional precautions
- POSTINJECTION CARE
- Postinjection inflammatory reaction
- Subcutaneous atrophy and depigmentation
- Intra-articular calcifications
- Effects on growing articular cartilage
- SYSTEMIC EFFECTS OF INTRA-ARTICULAR GLUCOCORTICOIDS