musculoskeletal and connective tissue disorders
How To Do Elbow Arthrocentesis
Step by Step Description of Elbow Arthrocentesis
Palpate the lateral elbow to identify the radial head, which can be felt rotating when the patient alternately pronates and supinates the wrist. Also identify the lateral epicondyle and the olecranon process. Joint effusion, if palpable, can be felt between these three landmarks. If desired, mark the needle entry site with a skin-marking pen or preferably an indentation (before cleansing the skin). Rest the elbow 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. Palpate the landmarks. Aspirate the joint using a 20- or 22-gauge needle on a 10- to 20-mL syringe. Aiming toward the medial epicondyle, insert and advance the needle. 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 the 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. Inspect the fluid for blood and fat. Transfer synovial fluid to tubes and other transport media for Synovial fluid examination . 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. 