eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures

Arthrocentesis, Shoulder

Author: Stephen Kishner, MD, MHA, Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans
Coauthor(s): Jaimie A Clodfelter, DO, Resident Physician, Department of Physical Medicine and Rehabilitation, Louisiana State University Health Science Center; Brett J Rothaermel, MD, PT,, Staff Physician, Department of Physical Medicine and Rehabilitation, Louisiana State Health Science Center
Contributor Information and Disclosures

Updated: Jul 21, 2009

Introduction

Shoulder arthrocentesis can be performed diagnostically for identification of the etiology of acute arthritis or therapeutically for drainage of an effusion. Using the same technique, the joint can be injected therapeutically with corticosteroids, anesthetics, or both.

The practitioner performing the procedure should be familiar with the anatomy of the glenohumeral joint and surrounding structures in order to avoid complications. The glenohumeral joint of the shoulder is formed by the humeral head and the glenoid fossa of the scapula. It is bounded by the acromion. The subdeltoid bursa lies under the deltoid muscle and covers the lateral and superior aspect of the proximal humerus. The neurovascular bundle lies medially in the axilla.

Aspiration of the glenohumeral joint can be accomplished from an anterior or posterior approach. The posterior approach allows the patient to be blinded from the procedure, and it mimics the approach used in arthroscopy of the joint.

Indications

  • Diagnostic injection of anesthetic (with or without corticosteroid) into the glenohumeral joint to determine if it is the source of the patient's pain
  • Therapeutic injection to provide pain relief and functional improvement in glenohumeral osteoarthritis, rheumatoid arthritis, or adhesive capsulitis (This may be performed through drainage of an effusion, septic joint, or hemarthrosis or through instillation of medication.)
  • Joint aspiration to aid in the diagnosis of the underlying pathologic process through synovial fluid analysis1

Contraindications

  • Bacteremia, cellulitis of overlying skin, and adjacent osteomyelitis are often considered absolute contraindications because of the potential risk of seeding the joint with bacteria. In these situations, the procedure should only be performed the clinician strongly suspects septic arthritis as the cause of overlying inflammatory changes, and then only after consultation with an orthopedist.
  • Relative indications include glenohumeral joint infection, chronic infection distant to injection site, allergy to injectate, diabetes mellitus, or uncontrolled coagulopathy.

More on Arthrocentesis, Shoulder

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

  1. Lin HM, Learch TJ, White EA, Gottsegen CJ. Emergency joint aspiration: a guide for radiologists on call. Radiographics. Jul-Aug 2009;29(4):1139-58. [Medline].

  2. Walsh NE, Rogers JN. Injection procedures. In: DeLisa JA, Gans BM, Walsh, eds. Physical Medicine & Rehabilitation: Principles and Practice. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:Chapter 14.

  3. Partin WR. Emergency procedures. In: Stone CK, Humphries RL, eds. Current Diagnosis & Treatment: Emergency Medicine. 6th ed. The McGraw-Hill Companies; 2008:Chap 6.

  4. Braddom R. Peripheral joint, soft tissue and spinal injection technique. In: Bushbacher R, et al, eds. Physical Medicine & Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Inc; 2007:541-562. [Full Text].

  5. Fields TR, Berman JR. Arthrocentesis, Intraarticular Injection and Synovial Fluid Analysis. In: Paget SA, Gibofsky A, Beary JF, Sculco TP. Hospital for Special Surgery Manual of Rheumatology and Outpatient Orthopedic Disorders. 5th ed. 2005:8.

  6. Reichman EF, Waddell R. Arthrocentesis. Access Emergency Medicine. Available at http://www.accessem.com/content.aspx?aid=52306. Accessed October 20, 2008.

  7. Sweiss N, Millstein ES, Primus G, et al. Aspiration Techniques and Indications for Surgery, Septic Arthritis. eMedicine from WebMD. Updated April 1, 2009. Available at http://emedicine.medscape.com/article/1268807-overview. Accessed October 15, 2008.

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Further Reading

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Keywords

shoulder arthrocentesis, glenohumeral arthrocentesis, shoulder injection, glenohumeral injection, steroid injection, corticosteroid injection, aspiration, joint aspiration, synovial fluid aspiration, adhesive capsulitis, osteoarthritis, rheumatoid arthritis, monoarticular arthritis, effusion, anterior approach, posterior approach

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Contributor Information and Disclosures

Author

Stephen Kishner, MD, MHA, Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans
Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jaimie A Clodfelter, DO, Resident Physician, Department of Physical Medicine and Rehabilitation, Louisiana State University Health Science Center
Jaimie A Clodfelter, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Brett J Rothaermel, MD, PT,, Staff Physician, Department of Physical Medicine and Rehabilitation, Louisiana State Health Science Center
Brett J Rothaermel, MD, PT, is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Orleans Parish Medical Society
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: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Chief Editor

Rick Kulkarni, MD, Medical Director, 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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