musculoskeletal and connective tissue disorders
How To Do Shoulder Arthrocentesis
Step by Step Description of Shoulder Arthrocentesis
Palpate the glenohumeral joint to identify the clavicle, the coracoid process, and the humeral head. If desired, mark the needle entry site with a skin-marking pen or preferably an indentation (before cleansing the skin). 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 entry site using a 25-gauge needle. Then inject more anesthetic along the anticipated trajectory of the arthrocentesis needle, but do not enter the joint space. Palpate the landmarks, including the coracoid and the humeral head. Aspirate the joint using a 20-gauge needle. Enter the skin perpendicularly, inferiorly, and lateral to the coracoid process and medial to the humeral head. Direct the needle posteriorly, toward the glenoid rim, and gently pull back 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, hold the hub of the needle motionless (using a hemostat if available) while removing the synovial fluid-containing syringe and replace it with the medication-containing syringe. If the needle has remained in place in the joint space, there will be no resistance to medication injection. 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. 