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Concept
Arthrocentesis
Summary
Arthrocentesis, or joint aspiration, is the clinical procedure performed to diagnose and, in some cases, treat musculoskeletal conditions. The procedure entails using a syringe to collect synovial fluid from or inject medication into the joint capsule. Laboratory analysis of synovial fluid can further help characterize the diseased joint and distinguish between gout, arthritis, and synovial infections such as septic arthritis.
In general, arthrocentesis should be strongly considered if there is suspected trauma, infection, or effusion of the joint.
Arthrocentesis can be used to diagnose septic arthritis or crystal arthropathy. In the case of a septic joint, arthrocentesis should preferably be performed prior to starting treatment with antibiotics, in order to ensure a proper sample of synovial fluid is obtained.
Patients with a fever, suspected flare of existing arthritis, or unknown cause of joint effusion should undergo arthrocentesis with synovial fluid analysis. Samples of synovial fluid can be analyzed for gross appearance, presence of crystals, white blood cell count with differential, red blood cell count, and bacterial culture. Normal synovial fluid should not have any cells or crystals present and should appear colorless and clear.
Gross Appearance: Opaque-appearing synovial fluid may indicate the presence of white blood cells, red blood cells, or acellular material such as lipids. Yellow-green appearing synovial fluid may indicate the presence of inflammation or infection. In the case of an infection or septic arthritis, the synovial fluid may contain pus and be more viscous.
Crystal Analysis: Using a microscope and polarizing light filter, birefringence of crystals can be detected in a sample of synovial fluid. This is essential to distinguish monosodium urate crystals in gout from calcium pyrophosphate dihydrate crystals in pseudogout.
Cell Count and Differential: In cases of bacterial joint infections, synovial fluid will typically show white blood cell counts of 50,000 to 150,000 cells/mm3.
Official source
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