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Joint aspiration or injection in adults: Technique and indications

Author
W Neal Roberts, Jr, MD
Section Editor
Daniel E Furst, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

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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Literature review current through: Sep 2017. | This topic last updated: Oct 13, 2017.
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