Elbow Arthrocentesis

Arthrocentesis involves both the puncture of a joint and the aspiration of its synovial fluid. ^{[1, 2]} It is typically used to make an accurate diagnosis of a painful, warm, swollen joint. Removal of excess fluid can be therapeutic. Analysis of the removed fluid helps to decipher its etiology. ^[3]

The most emergent diagnosis of consideration, a septic joint, occurs less frequently in the elbow than in larger joints (5-10%), with the exception of cases in which Neisseria gonorrhoeae is the pathogen. ^[4]  For more information, see Surgical Treatment of Septic Arthritis.

Diagnostic

Before the procedure, periarticular processes such as bursitis, tendinitis, contusions, and cellulitis must be excluded on clinical grounds. Performing an arthrocentesis with the goal of obtaining synovial fluid to send for analysis is useful for the following purposes:

• Evaluation of a nontraumatic acute monoarticular arthritis
• Evaluation of a suspected infection in an elbow (eg, septic arthritis) ^{[5, 6]}
• Evaluation of a possible inflammatory cause of an effusion (eg, gout, pseudogout, ^[7] rheumatologic disorders, reactive arthropathies)
• Differentiation of an occult fracture not clearly visualized on radiographs from an inflammatory cause by the presence of an hemarthrosis

To date, the diagnostic value of elbow joint aspiration for periprosthetic elbow infection has not been established. ^[8]

Therapeutic

A large effusion caused by fluid or blood is painful and leads to significant impairment of joint mobility. Removal of synovial fluid as a therapeutic modality is useful for the following purposes:

• Relief of pain
• Improvement of mobility
• Instillation of medications
• Repeated arthrocentesis for a septic elbow in carefully selected patients as a means of decreasing bacterial load and avoiding surgical debridement (only under the discretion of the orthopedic specialist)

Elbow arthrocentesis has been employed as an initial treatment measure in patients with radial head fractures; however, a 2014 Cochrane review did not find sufficient evidence to permit determination of the effectiveness or safety of this procedure in adults. ^[9]  A subsequent systematic review by de Muinck Keizer et al found that in patients with Mason type I radial head fractures, aspiration of hematoma appeared to be safe and effective. ^[10]

Arthrocentesis through overlying cellulitis is controversial because of concerns about seeding the joint with bacteria. This decision should be made in consultation with an orthopedist and with consideration of the potential risks and benefits.

Relative contraindications for elbow arthrocentesis include the following ^[1] :

• Overlying skin or soft-tissue infection (eg, cellulitis or abscess; see above)
• Overlying skin lesions (eg, dermatitis or psoriasis)
• Known bacteremia
• Bleeding diatheses
• Patient on anticoagulation medication
• Prosthetic joint (refer to orthopedic specialist)