Shoulder Arthrocentesis Periprocedural Care

Updated: Nov 27, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Equipment

Equipment for shoulder arthrocentesis consists of the following:

  • Alcohol sponges
  • Skin-cleansing agent (chlorhexidine or povidone-iodine)
  • Gauze
  • Gloves (clean nonsterile gloves are sufficient if no contact is made with skin or needle)
  • Local anesthetic
  • Specimen tubes
  • Corticosteroid
  • Bandage
  • Needles - 1.5-in., 25-gauge for anesthetic injection; 18- to 22-gauge for aspiration
  • Syringes - 3-5 mL for anesthetic injection; 5-20 mL for aspiration

A spinal needle may be needed for obese or muscular patients. If increased viscosity is suspected, a larger needle may be required. Larger needles make it easier to distinguish changes in resistance from tendons.

Adequate vacuum probably will not be generated from a syringe smaller than 5 mL. In some cases, a syringe larger than 50 mL may be required, but the practitioner should be cautious of excess suction. Excess suction may retrieve material other than fluid and may prevent aspiration. 

It is recommended that the practitioner use one needle and one syringe size, so as to become accustomed to a standard degree of resistance.

 

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Patient Preparation

The injection site should be inspected, palpated, and sterilized. If the site is incorrect, sterilization should be repeated at the new injection site.  The site should not be touched after sterilization. Because the site has been sterilized, sterile gloves are not required.  Although ethyl chloride spray is labeled as nonsterile, it has been found to maintain the sterility of injection sites. [7]

Anesthesia

Local anesthesia is recommended. (See Local Anesthetic Agents, Infiltrative Administration.) After skin preparation and identification of the needle insertion site, a 25-gauge needle is used to make a small skin wheal with local anesthetic into the subcutaneous tissue and then along the anticipated needle pathway.

Positioning

The patient should be seated in a comfortable position. For the anterior approach, the patient’s hand should be rested on his or her lap so that the shoulder is internally rotated. For the posterior approach, the patient’s hand should be placed on the contralateral shoulder.

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