II. Indications: Injection (Refractory to conservative measures)

  1. Osteoarthritis
  2. Rheumatoid Arthritis
  3. Gout
  4. Radial Head Fracture diagnosis
    1. Blood or fat globules on aspiration

III. Indications: Aspiration

IV. Contraindications

  1. Overlying infection (e.g. Cellulitis, abscess)
  2. Prosthetic Joints (consult orthopedics prior to Arthrocentesis)
  3. Hemarthrosis is not significantly increased with antiplatelet agents, or INR <4-5

V. Preparation

  1. Needle (with 5-10 cc syringe)
    1. Gauge
      1. Aspiration: 18 to 22
      2. Injection: 25 to 27
    2. Length: 1.5 inches
  2. Injection Solution
    1. Lidocaine 1%: 3-5 ml
    2. Corticosteroid options
      1. Methylprednisolone (40 mg/ml): 1-2 ml or
      2. Celestone Soluspan (3 mg/ml): 1-2 ml

VI. Technique: Lateral Elbow Approach

  1. Medial elbow approach is associated with increased risk of complication (Lateral approach is preferred)
    1. Ulnar Nerve injury
    2. Superior ulnar collateral artery injury
  2. Position patient
    1. Patient seated
    2. Elbow flexed at 90 degrees
    3. Forearm pronated (palm-side down)
  3. Mark landmarks of lateral triangle
    1. Consider Bedside Ultrasound
    2. Lateral olecranon
    3. Lateral epicondyle
    4. Radial head
  4. Prepare the skin surface
    1. Mark the center of the lateral triange
    2. Chlorhexidine or povidone-Iodine
    3. Sterile drape
    4. Subdermal injection of Anesthetic at entry
  5. Needle insertion
    1. Insert needle perpendicular to skin
    2. Needle inserted at center of lateral triangle (see above)
    3. Needle aimed toward medial epicondyle
    4. Redirect needle if bone reached
    5. Aspirate for blood prior to injection

VII. Complications

VIII. References

  1. Mohammadieh (2017) Crit Dec Emerg Med 31(7):12-3
  2. Pfenninger (1994) Procedures, Mosby, p. 1045
  3. Cardone (2002) Am Fam Physician 66(11):2097-100 [PubMed]

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Related Studies

Ontology: Aspiration of elbow joint (C0559699)

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