Arthrocentesis: Elbow (Training Physician)

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  • Diagnostic evaluation of acute monoarticular or polyarticular arthritis
  • Therapeutic treatment of acute joint effusions
  • Overlying skin infections or lesions
  • Arthrocentesis is probably safe in patients with a coagulopathy, unless the coagulopathy is severe.
  • However, the safety of arthrocentesis in patients with abnormal coagulation is not established.
  • Bacteremia
  • Skin cleansing agent (e.g., chlorhexidine or povidone-iodine)
  • Sterile gauze
  • Local anesthetic (1% lidocaine is acceptable)
  • Small (e.g., 5 mL) syringe with 25-gauge needle for anesthetic injection
  • Syringe (5-10 mL) with 1-inch 22-gauge needle for joint aspiration
  • Specimen tubes for submission of synovial fluid to the laboratory; typically, an EDTA tube is used for cell count and differential, and a lithium heparin tube is used for crystal examination
  • Bandage
  • Elastic wrap (to be applied after large joint aspirations)
  • Gloves
  • The elbow joint is a hinge joint formed by the distal humerus and proximal ulna at the olecranon.
  • The olecranon bursa lies posteriorly at the angle of the olecranon.
  • The ulnar nerve is located in the posterior aspect of the joint, in the ulnar groove of the distal humerus.
  • The needle enters in the triangular depression between the lateral epicondyle, the radial head, and the olecranon process of the ulna.

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  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Monitor for signs of infection in the region.
  • An elastic bandage may be placed around the joint to provide patient comfort and reduce re-accumulation of the effusion.
  • Treat suspected septic arthritis before formal diagnosis.
    • The choice of antibiotic may be made empirically, or based upon the gram stain results.
    • Intra-articular antibiotics are not recommended.
    • The joint capsule must be repeatedly drained until the effusion is cleared. Operative drainage may be needed.
  • Treatment of gout
    • High-dose nonsteroidal antiinflammatory agents, colchicine, and oral steroids may be used.
    • Antihyperuricemia treatment should be delayed.
  • Treatment of pseudogout
    • Treatment is identical to that for acute gout. Antihyperuricemic agents are not used.
  • Complications are uncommon.
  • Iatrogenic infection
  • Iatrogenic hemorrhage
  • Pain during the time of the procedure
  • Reaccumulation of the joint fluid.
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