Arthrocentesis



Test Description


An arthrocentesis is the insertion of a sterile needle into a joint space to obtain a
sample of synovial fluid for analysis. Although the procedure may be performed on
any joint, the knee is the most common site. Arthrocentesis is used to assist in the
differential diagnosis of arthritis, to investigate joint effusion, and to remove excess
fluid from the joint, which may be causing pain for the patient. If indicated, corticosteroids
may be injected into the joint following fluid sample acquisition.

Normal Values

Synovial fluid is clear to straw colored with 0–200 white blood cells/μL, no crystals,
and a good mucin clot. Values for protein, glucose, and uric acid are similar to serum values.

Possible Meanings of Abnormal Values

Gout
Osteoarthritis
Pseudogout
Rheumatic fever
Rheumatoid arthritis
Septic arthritis
Systemic lupus erythematosus
Traumatic arthritis
Tuberculous arthritis

Interventions/Implications

Pretest

• Explain to the patient the purpose of the test. Provide any written teaching materials
available on the subject. Note that minimal discomfort during the test is due to the injection
of the local anesthetic.
• Obtain a signed informed consent.
• No fasting is required prior to the test.

Procedure

• The patient is assisted to a supine position.
• The skin is cleansed with an antiseptic, and the skin overlying the puncture site is
   anesthetized.
• A needle is inserted into the joint space. A minimum of 10 mL of fluid is aspirated for
   analysis.
• If indicated, the needle is left in place, and a syringe containing a steroid is attached.
• After the steroid is injected, the needle is withdrawn.
• Pressure is applied to the puncture site, followed by a sterile dressing.
• Gloves are worn throughout the procedure.

Posttest
• The patient may experience discomfort after the procedure. The patient is instructed to rest
the joint for 12 hours after the test. Elastic wraps, ice applications, and mild analgesics may
be used. Strenuous activity should be avoided until approved by the primary care provider.
• Assess the joint for redness, swelling, and tenderness.
• Report abnormal findings to the primary care provider.

Clinical Alert                          

• Possible complications include hemarthrosis and joint infection

   CONTRAINDICATIONS!

 • Patients with joint infection or skin infection near proposed site of arthrocentesis

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