II. Indications: Injection (Refractory to conservative measures)
- Osteoarthritis
- Rheumatoid Arthritis
- Gout
-
Radial Head Fracture diagnosis
- Blood or fat globules on aspiration
III. Indications: Aspiration
IV. Contraindications
- Overlying infection (e.g. Cellulitis, abscess)
- Prosthetic Joints (consult orthopedics prior to Arthrocentesis)
- Hemarthrosis is not significantly increased with antiplatelet agents, or INR <4-5
V. Preparation
- Needle (with 5-10 cc syringe)
- Gauge
- Aspiration: 18 to 22
- Injection: 25 to 27
- Length: 1.5 inches
- Gauge
- Injection Solution
- Lidocaine 1%: 3-5 ml
- Corticosteroid options
- Methylprednisolone (40 mg/ml): 1-2 ml or
- Celestone Soluspan (3 mg/ml): 1-2 ml
VI. Technique: Lateral Elbow Approach
- Medial elbow approach is associated with increased risk of complication (Lateral approach is preferred)
- Ulnar Nerve injury
- Superior ulnar collateral artery injury
- Position patient
- Mark landmarks of lateral triangle
- Consider Bedside Ultrasound
- Lateral olecranon
- Lateral epicondyle
- Radial head
- Prepare the skin surface
- Mark the center of the lateral triange
- Chlorhexidine or Povidone-Iodine
- Sterile drape
- Subdermal injection of Anesthetic at entry
- Needle insertion
- Insert needle perpendicular to skin
- Needle inserted at center of lateral triangle (see above)
- Needle aimed toward medial epicondyle
- Redirect needle if bone reached
- Aspirate for blood prior to injection
VII. Complications
VIII. References
- Mohammadieh (2017) Crit Dec Emerg Med 31(7):12-3
- Pfenninger (1994) Procedures, Mosby, p. 1045
- Cardone (2002) Am Fam Physician 66(11):2097-100 [PubMed]
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Related Studies
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 281808001 |
| English | aspiration of elbow joint (treatment), aspiration of an elbow joint, aspiration of elbow joint, Aspiration of elbow joint, Aspiration of elbow joint (procedure) |
| Spanish | aspiración de articulación de hueso (procedimiento), aspiración de articulación de hueso |
