eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures

Arthrocentesis, Knee

Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Contributor Information and Disclosures

Updated: Feb 26, 2009

Introduction

Arthrocentesis (synovial fluid aspiration) can be performed diagnostically (for identification of the etiology of acute arthritis) or therapeutically (for pain relief, drainage of septic effusion, or injection of medications).1,2 The clinician performing the procedure should be familiar with the anatomy of the specific joint in order to avoid puncture of tendons, blood vessels, and nerves (see image below). Using the extensor surface of the joint for needle insertion, while keeping the joint in minimal flexion, minimizes the risk of such injuries.

Right knee.

Right knee.

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Right knee.

Right knee.


Anatomic landmarks.

Anatomic landmarks.

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Anatomic landmarks.

Anatomic landmarks.


Indications

  • Diagnostic
    • Evaluation of monoarticular arthritis
    • Evaluation of suspected septic arthritis
    • Evaluation of joint effusion
    • Identification of intra-articular fracture and ligamentous tear
    • Identification of crystal arthropathy
  • Therapeutic
    • Relief of pain by aspirating effusion or blood
    • Injection of medications (eg, corticosteroids, antibiotics, anesthetics)
    • Drainage of septic effusion

Contraindications

  • Absolute - None
  • Relative
    • Suspected septic joint (In this case, no contraindications exist.)
    • Cellulitis overlying the joint (If arthrocentesis is performed, the patient should be admitted for the administration of intravenous antibiotics, even if the synovial fluid is not suspicious for infectious arthritis.)
    • Skin lesion or dermatitis overlying the joint
    • Known bacteremia
    • Adjacent osteomyelitis
    • Uncontrolled coagulopathy
    • Joint prosthesis (A joint prosthesis is preferably tapped by an orthopedist.)

More on Arthrocentesis, Knee

Overview: Arthrocentesis, Knee
Treatment & Medication: Arthrocentesis, Knee
Multimedia: Arthrocentesis, Knee
References
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References

  1. Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. Jul 1 2003;68(1):83-90. [Medline]. [Full Text].

  2. Zuber TJ. Knee joint aspiration and injection. Am Fam Physician. Oct 15 2002;66(8):1497-500, 1503-4, 1507. [Medline]. [Full Text].

  3. Self WH, Wang EE, Vozenilek JA, del Castillo J, Pettineo C, Benedict L. Dynamic emergency medicine. Arthrocentesis. Acad Emerg Med. Mar 2008;15(3):298. [Medline].

  4. Thomsen TW, Shen S, Shaffer RW, Setnik GS. Videos in clinical medicine. Arthrocentesis of the knee. N Engl J Med. May 11 2006;354(19):e19. [Medline].

  5. [Best Evidence] Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis?. JAMA. Apr 4 2007;297(13):1478-88. [Medline].

  6. Li SF, Cassidy C, Chang C, Gharib S, Torres J. Diagnostic utility of laboratory tests in septic arthritis. Emerg Med J. Feb 2007;24(2):75-7. [Medline].

  7. McGillicuddy DC, Shah KH, Friedberg RP, Nathanson LA, Edlow JA. How sensitive is the synovial fluid white blood cell count in diagnosing septic arthritis?. Am J Emerg Med. Sep 2007;25(7):749-52. [Medline].

  8. Reichman and Simon. Emergency Medicine Procedures. 1st. New York: McGraw Hill; 2004.

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Further Reading

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Keywords

joint aspiration, joint tap, joint injection, arthrocentesis of the knee, knee arthrocentesis, knee joint tap, knee injection, knee steroid injection, knee joint aspiration, synovial fluid aspiration, arthritis, septic effusion, monoarticular arthritis, septic arthritis, joint effusion, intra-articular fracture, ligamentous tear, crystal arthropathy, effusion aspiration, septic joint, joint space, parapatellar approach, suprapatellar approach, infrapatellar approach, dry tap, synovium, fluid analysis, synovial fluid

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Contributor Information and Disclosures

Author

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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