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ABSTRACT: Joint aspiration may be used for diagnosis or for relieving pressure, and joint injection may be used for treatment. Physicians can easily become proficient in aspiration and injection techniques. Indications for aspiration include both acute and chronic arthritis; there are few absolute contraindications. Intra-articular injections of medication usually are an adjunct to other treatment modalities. Indications for corticosteroid injections include acute crystal-induced arthritis; complications are rare. Less soluble agents remain in a joint space longer than more soluble agents and should have a longer duration of action. Physicians should perform injections wearing gloves and using aseptic technique. No one technique has proved to be optimal. After an aspiration or injection, the patient should be given detailed instructions. (J Musculoskel Med. 2011;28:216-222)
Two primary indications call for inserting a needle into a joint: (1) aspiration of fluid for diagnostic purposes or for relieving pressure within a swollen joint and (2) injection of medications. Joint aspiration and intra-articular injection are useful and somewhat safe procedures that physicians who treat patients with musculoskeletal conditions can perform readily at the bedside. Clinicians usually can learn and become proficient in aspiration and injection techniques in a limited amount of time. In appropriate cases, joint injections are a valuable adjunct to medical therapies, rehabilitation, and surgery.
In this article, we address the indications and contraindications for joint aspiration and intraarticular injection. We also discuss the potential complications, available therapies, technical aspects of injection, and the possible role of ultrasonography-guided procedures.
Indications and contraindications for joint aspiration
Diagnostic indications include acute arthritis (sepsis, crystal arthritis [monosodium urate; calcium pyrophosphate; basic calcium phosphates, such as hydroxyapatite; oxalate; cholesterol], and hemorrhagic [trauma]) and chronic arthritis (inflammatory [crystal arthritis, rheumatoid arthritis, spondylarthritis] and noninflammatory [osteoarthritis, osteonecrosis]). Treatment indications include reduction of intra-articular pressure, injection of medication (local anesthetic, corticosteroids, hyaluronic acid, and other agents [radioisotopes, such as yttrium; infliximab]), repeated aspiration for sepsis, and saline.
It could be argued that joint aspiration should be performed in any patient who presents with a painful joint or joints and evidence of effusion of unknown causes. Synovial fluid analysis is one of the most sensitive and inexpensive investigations for differentiating various pathologies, including infection, immunemediated inflammation, crystalinduced...