The fluid should then be transferred to a sterile specimen collection cup and sealed for transport to the laboratory for analysis. On obtaining access to the joint, negative pressure should be maintained in the syringe until an adequate amount of synovial fluid is collected. A spinal needle may be an option for deeper joints or patients with anatomy complicated by obesity. Next, a large gauge, sharp needle, typically 18 gauge (or smaller if a smaller joint in being aspirated), is inserted into the joint attached to a minimum 10 cc syringe. Local anesthetic can be used to create a cutaneous/subcutaneous wheel for local pain control. The site is then prepped and draped in the usual sterile fashion using antiseptics that include one or a combination of alcohol, betadine, and/or chlorhexidine. The literature documents the safe entry portals thoroughly for the shoulder, elbow, wrist, hip, knee, and ankle. Once indications are met for arthrocentesis, aspiration site is selected and marked. Fluoroscopy and CT guided arthrocentesis can also provide utility for deeper joints including shoulder and hip. Ultrasound technology may be useful in ensuring correct needle placement but is often unnecessary. Sterility is essential not only to prevent transmission of infection but also to ensure accurate fluid analysis. This procedure should be done under sterile procedural conditions and performed by a physician with intimate knowledge of the involved anatomy. ProceduresĪrthrocentesis is the process by which synovial fluid collection occurs by penetrating the joint space through aspiration. Aspiration should be performed by a trained physician under sterile procedural protocol to prevent the risk of infection and contamination of the aspirate. Arthrocentesis can also be performed therapeutically for pain relief in a painful joint in which case an effusion or hemarthrosis is preventing a full range of motion of the involved joint. In settings in which intra-articular injection is a consideration, aspiration should be performed before injection as the aspirated fluid should first undergo inspection for any gross abnormalities or signs of gross infection. In the presence of joint effusion, joint pain of unknown etiology, or suspected infection within a joint space, arthrocentesis can aid in diagnosis. When patients present with acutely painful joints with suspicion of infection, inflammation or non-inflammatory causes of effusion, synovial fluid aspiration and analysis is imperative to aid in diagnosis and direct treatment modality. Physiologic changes in synovial fluid volume and content occur in response to trauma, inflammation, and bacterial, fungal, or viral penetrance. Synovial fluid production is from fibroblast like type B synovial cells. Synovial fluid is produced as an ultrafiltrate of blood plasma and is primarily composed of hyaluronan, lubricin, proteinase, collagenases, and prostaglandins. Synovial fluid is physiologic, and acts as a joint space lubricant of articular cartilage, and nutrient source through diffusion for surrounding structures including cartilage, meniscus, labrum, etc. Synovial fluid is defined as the collection of fluid confined within a joint space.
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