Joint puncture is performed with a 10-20 g syringe, with a needle 5-6 cm long and 1-2 mm thick. Thin needles are used to inject medications into the joint when there is no need to take fluid from the inside, which can significantly reduce trauma. For pumping, 2 mm needles are used, which reduces the risk that they will become clogged with solid particles. The doctor is required to make extremely careful movements. Thus, the needle should not enter the joint capsule more than 1-1.5 cm, and the slightest vibrations of the tip when it passes through the synovial membrane seriously injure it. There is a technique that prevents infection and leakage of joint contents through the hole: the skin must be pulled back, thereby achieving curvature of the puncture cavity. In order to reduce the risk of pathologies, a tight bandage is applied to the leg after puncture, or it is immobilized with a splint. To prevent complications, the doctor carefully monitors the progress of healing, although outpatient treatment is also possible.
Content
- The essence of the procedure for puncture of the shoulder joint
- Who carries out the treatment?
- Why do they contact us?
- Expert opinion
- Reviews from our patients
- Sign up for treatment
The essence of the procedure for puncturing the shoulder joint is to puncture the joint at a certain point, followed by removal of the pathological fluid. The whole process is absolutely painless and takes no more than 20-30 minutes.
After the procedure, medications are injected into the joint cavity in order to prevent further accumulation of pathological fluid. You can learn about how this procedure works from the reviews of other patients, as well as from the photo of the puncture (piercing) of the shoulder joint on the website.
Puncture of the shoulder joint is performed with a syringe with a volume of 10-20 ml. The skin and soft tissues are preliminarily anesthetized with lidocaine or novocaine. A large syringe is needed to pump out the maximum amount of fluid from the joint in a minimum number of manipulations.
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Risks and complications
The synovial membrane, which makes up the walls of the joint capsule, is a delicate tissue, damage to which will take a long time to recover and can cause pathological processes. It is also especially vulnerable to microbes, so strict antiseptic rules apply. So, the surface of the joint is disinfected in two ways: twice with iodine, then with alcohol. You need to be careful here: iodine, penetrating into the wound at the tip of the needle, can cause a chemical burn to the membrane. Instruments are sterilized by chemical and thermal means. If a joint puncture is performed on a healthy joint for the purpose of sampling, it reduces the already small volume of synovial fluid. Excessive amounts of punctate can lead to the onset of inflammatory processes and cartilage destruction. Also, due to the negative pressure in the bag, osmosis of water and other foreign impurities from the synovial fluid occurs through its walls, and a decrease in its quantity will negatively affect this process.
Prices for joint puncture
| Services | Price | Sign up |
| Puncture of the hand | 2000 rub | Sign up |
| Knee joint puncture | 3000 rub | Sign up |
| Puncture of the elbow joint | 2000 rub | Sign up |
| Shoulder joint puncture | 3000 rub | Sign up |
| Ultrasound-guided hip puncture | 3000 rub | Sign up |
Indications and contraindications for the diagnostic procedure
Joint pain, swelling and redness, or recent injury can all be reasons to schedule a procedure. Synovial fluid examination is carried out to identify the causes of joint diseases.
Among them:
- acute and chronic inflammation of the joints caused by microorganisms (bacteria, viruses, fungi);
- rheumatoid arthritis;
- systemic lupus erythematosus;
- ankylosing arthritis;
- systemic sclerosis;
- reactive arthritis and other aseptic arthritis;
- metabolic disorders associated with arthritis - gout, pseudogout (chondrocalcinosis);
- osteoarthritis;
- other causes of excessive fluid accumulation in the joints.
Contraindications to joint puncture and examination of synovial fluid are:
- skin infection around the joint (risk of transferring germs into the joint);
- bleeding disorders or taking drugs that reduce blood clotting (anticoagulants): INR > 1.5 or aPTT twice the normal;
- platelet count <50,000/mm3.
If an X-ray examination with contrast (arthrography) is prescribed, a puncture is performed to provide access to the intra-articular cavity. In this case, the list of indications and contraindications expands.
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Indications
- Biochemical analysis of punctate, as well as a test for the presence of impurities (pus or blood from injuries and inflammatory processes).
- Using radiography and drugs that block the rays, you can get accurate information about meniscus damage. In this case, the drug is injected directly into the bag.
A lot of information is obtained not from laboratory analysis, but directly during surgery. When the liquid begins to flow into the syringe, monitor it. Pay attention to color, consistency, presence of blood or purulent impurities. Sometimes novocaine is used for this, which tends to change color and viscosity upon contact with foreign biological fluids. Biochemical analyzes of punctate make it possible to identify pathologies in the metabolic processes occurring in the bag. In addition to the mechanical function, it performs a nutritional function: it delivers necessary substances to avascular cartilage.
- Pumping out exudate, blood and pus from the cavity of the joint capsule. Indicated for acute inflammatory processes.
- Administration of various medications. For example, local anesthesia for operations and painful manipulations. For inflammation - antibiotics, corticosteroids.
- With hemarthrosis, hematomas appear in the joint cavity, which impede motor function and contribute to the development of infection, so puncture of blood from them is indicated.
There is a third indication - the introduction of oxygen into the joint capsule. It is used for degenerative-dystrophic lesions of the musculoskeletal system, for humeroscapular periarthritis, joint arthrosis, or as a means of preventing post-traumatic arthrosis. This method has only one contraindication - the presence of acute purulent-inflammatory processes at the puncture site. Medical oxygen and a specialized instrument are used, although it is possible to use other equipment, such as a device for blowing out the fallopian tubes.
How is biomaterial analyzed?
The examination of synovial fluid is performed under a microscope and consists of assessing a number of parameters. Among them:
- color, transparency and viscosity of the liquid, its pH;
- glucose, protein, uric acid and lactate dehydrogenase (LDH) levels;
- number of leukocytes and other cells;
- assessment of the presence of bacteria, if necessary, a culture is prescribed (microbiological test).
Depending on the results, the doctor decides on further diagnosis of the disease or initiation of therapy.
Functions of synovial fluid
The main functions of synovial fluid are: locomotor, metabolic, trophic. In the first case, synovial fluid, together with articular cartilage, allows free movement of the articulated surfaces of the bone. In the second, synovial fluid participates in the metabolic processes that occur between the vascular layer and the articular fluid.
Trophic function means that synovial fluid performs a nutritional function for the avascular layers of cartilage. If inflammation occurs in the joint, the protein content in the synovial fluid increases. This is due to an increase in vascular permeability. The liquid subsequently becomes cloudy, the content of neutrophilic leukocytes increases, which occurs as a consequence of acute traumatic synovitis.
Preparation
Puncture of the knee joint is an outpatient procedure for which no special preparation is required. Situations have arisen more than once when the procedure was carried out urgently, because there was simply no time to take tests. If the operation is not urgent, then blood and urine tests may be taken from the patient. The quality of blood clotting is also determined, and the patient is sent for an X-ray, computed tomography or ultrasound.
The next stage of preparation for the operation is that the doctor finds out if the patient has an allergic reaction to anesthetics. There are people who are allergic to standard painkillers, but they can be replaced with other drugs that do not differ in quality from the standard ones.
Types of puncture
There are three approaches for this surgery: anterior approach, lateral approach and posterior approach.
Anterior Approach – This approach is performed along the coracoid process of the scapula and can be palpated 3 cm distal to the acromial end of the clavicle. The needle is inserted distal to the coracoid process of the scapula, and then it is inserted 3 to 4 cm deep between the head of the humerus and the coracoid process.
Content:
- Types of puncture
- Joint anatomy
- Joint fluid
- Functions of synovial fluid
- Indications for puncture
- Method of performing the procedure
Lateral approach - with this approach, the needle is inserted from the acromion of the scapula in the frontal plane and below through the deltoid muscle. Posterior approach - with this approach, the needle is inserted from the acromion between the deltoid muscle, namely its posterior edge, and the lower edge of the supraspinatus muscle, below, perpendicular and 4 to 5 cm in depth from the point of insertion.
Symptoms
Hemarthrosis of the 1st degree is diagnosed after a small amount (up to 15 ml) of blood gets into the joint. But in this case the symptoms are mild. The predominant clinical picture is associated not with the hemarthrosis itself, but with the injury that led to it. A person has pain in his knee, but there is no feeling of fullness inside the joint. The patient limps when walking. Joint blockade or instability is possible.
With grade 2 hemarthrosis, more than 15 ml of blood flows into the joint. In this case, clinical symptoms associated directly with hemorrhage appear. The skin along the edges of the patella bulges, forming a “horse saddle”-shaped depression in the area where it is located. During an objective examination, the doctor palpates the knee joint and detects increased mobility of the patella. When you press on it, you feel free fluid inside the joint.
With grade 3 hemarthrosis, more than 100 ml of blood flows into the knee. The patient experiences a feeling of fullness in the joint. A symptom of balloting appears. It is determined objectively. With the patient's leg straightened, the doctor presses on the patella, after which it sinks into the joint. After the doctor releases it, the patella “floats up”. It can also become dislodged with a light blow to the thigh.
Anesthesia
Anesthesia
- the possibility of infection should be taken into account, therefore compliance with the rules of asepsis and antisepsis is mandatory;
- the skin cannot be sterile even after treatment with antiseptics, therefore, in order not to spread infection from the surface of the skin into the joint, the doctor squeezes out the first portion of the anesthetic immediately after passing through the skin (thus, the remains of the skin with bacteria are pushed out of the needle, but they get under the skin, and not inside the joint);
- for anesthesia in people with a tendency to allergies, it is better to use lidocaine;
- after withdrawing the anesthetic from the ampoule, the needle should be replaced;
- antiseptics do not kill bacteria instantly, but within 1 minute, so the doctor first lubricates the skin with iodine and alcohol, and then draws the medicine into a syringe (during this manipulation, enough time passes for the death of most microorganisms on the surface of the skin in the area through which it will be insert the needle);
- puncture of the knee can be performed through different points, but if possible it is done from the outside, since in this case the patient experiences less severe pain.
The doctor inserts the needle into the joint no more than 1-2 cm to avoid injury to the cartilage or the needle coming out of the joint cavity. An injection into the cartilage is not so much dangerous as it is painful for the patient. In addition, it can clog the needle, making pumping blood through it impossible.
After puncture of the knee, the skin puncture site is lubricated with alcohol. Then it is sealed with a napkin.