musculoskeletal and connective tissue disorders
How To Do Wrist Arthrocentesis
Step by Step Description of Wrist Arthrocentesis
Palpate the dorsal aspect of the wrist to identify the Lister tubercle, which is the bony prominence palpable on the distal dorsal radius. Isolate and identify the extensor pollicis longus tendon by directing the patient to extend the thumb. Needle entry occurs distal to the tubercle and ulnar to the tendon. If desired, mark the insertion site with a skin-marking pen or preferably an indentation (before cleansing the skin). Rest the forearm and hand on an underpad. Prepare the area with a skin-cleansing agent, such aschlorhexidineor povidone iodine, then use an alcohol wipe to remove the agent. Place a wheal of local anesthetic over the needle entry site using a 25- to 30-gauge needle. Then inject more anesthetic along the anticipated trajectory of the arthrocentesis needle (about 0.5 to 1 cm), but do not enter the joint space. Aspirate the joint using a 22- or 20-gauge needle on a 10-mL syringe. Have an assistant apply axial traction, slight flexion (20 to 30°), and ulnar deviation to the hand to facilitate needle entry into the joint space. Insert the needle perpendicular to the skin, just distal to the Lister tubercle and on the ulnar side of the extensor pollicis longus tendon. Direct the needle volarly toward the joint space, and pull back gently on the plunger as you advance. Synovial fluid will enter the syringe when the joint is entered. If the needle hits bone, retract almost to skin surface and then redirect at a different angle. Drain all fluid from the joint. If intra-articular medications (eg, anesthetic, corticosteroid) are to be given, use a hemostat to hold the hub of the needle motionless while removing the synovial fluid-containing syringe and attaching the medication-containing syringe. If the needle has remained in place in the joint space, there will be no resistance to medication injection. Injections into the radiocarpal joint should not exceed 1 mL in volume. After injecting a corticosteroid, move the joint through full range of motion to distribute the medication throughout the joint. Transfer synovial fluid to tubes and other transport media for Synovial fluid examination . Inspect the fluid for blood and fat. Apply an adhesive bandage or sterile dressing. © Elsevier Inc. All Rights Reserved. This video is for personal informational use. Users are prohibited from copying, reproducing, licensing, subscribing, selling, leasing or distributing this video. 