Overview of Wrist Arthrocentesis
Wrist arthrocentesis is a medical procedure where the fluid around the wrist joint is drawn out using a needle. Think of it like draining the unwanted fluid from a patient’s wrist. It’s a clean procedure that can be used for two main purposes: relief (therapeutic) or diagnosis. This procedure can be carried out in an emergency room or a regular doctor’s office by trained healthcare workers who have the know-how of this procedure. By doing it this way, they limit any risks or complications associated with the process.
Anatomy and Physiology of Wrist Arthrocentesis
When a doctor needs to draw fluid from your wrist joint, which is also known as ‘wrist arthrocentesis’, they need to think about certain structures in your wrist. These structures include:
* The bottom end of the radius bone, which is one of the two long bones in your forearm.
* The ‘anatomic snuffbox’, a small, V-shaped area on the back of your hand, just below your thumb.
* The ‘extensor carpi radialis brevis’, a muscle that helps move your wrist.
* The ‘extensor pollicis longus’, a muscle that helps move your thumb.
The doctor will feel for the space between your wrist bones, which is just below the radius bone and on the side, closer to your thumb. They make sure to avoid the ‘extensor carpi radialis brevis’ and ‘extensor pollicis longus’ muscles. They can also reach this joint space from the side of your wrist closer to your little finger. From this angle, they’ll feel for the space just below the bottom end of your ulna, which is the other long bone in your forearm.
Why do People Need Wrist Arthrocentesis
Wrist arthrocentesis is a medical procedure that can help doctors diagnose or treat certain health conditions. This procedure involves the drawing out of fluid from a joint in your wrist. Here’s a straightforward explanation of the several reasons why your doctor might recommend this procedure:
- Septic arthritis: This is a serious and painful infection in a joint. An arthrocentesis can help judge how treatment for the infection is responding.
- Acute monoarticular arthritis: Here’s a long term for a condition that’s also quite painful. It refers to arthritis that affects just one joint. Arthrocentesis can help diagnose this condition.
- Inflammatory joint effusion: Sometimes, fluid builds up in a joint because of inflammation. This procedure can confirm the diagnosis.
- Intra-articular injection of medications: Doctors often use this procedure to inject medications directly into the joint.
- Aspiration of large painful joint effusions: This term might sound complicated, but it essentially means drawing out fluid from a swollen joint, to reduce pain and pressure.
- Recurrent aspiration: If your joint fluid has been removed before but needs to be removed again, your doctor might suggest wrist arthrocentesis.
Remember, your doctor will always provide more detailed information about these conditions and what the procedure involves, so don’t hesitate to ask them any questions you may have.
When a Person Should AvoidWrist Arthrocentesis
Wrist arthrocentesis, which involves removing fluid from the wrist joint for diagnosis or treatment, can be done for almost anyone. However, there are some circumstances where it might not be recommended. These include:
If there’s an infection of the skin (cellulitis) or bloodstream (bacteremia), or a skin wound over the area, it’s better to avoid the procedure to prevent further complications. If a person has an artificial joint, the procedure should ideally be performed by surgeons using ultra clean methods to avoid infection.
Other factors to consider are a fragile or damaged wrist joint, or a recent wrist fracture. In such cases, the procedure might cause further damage or discomfort.
Before going ahead with wrist arthrocentesis, the doctor will look into any blood-related issues. This could be coagulopathic (problems with blood clotting) or bleeding disorders, low platelet count (thrombocytopenia), or use of any blood-thinning medicine (anticoagulants). If these are present, the healthcare provider may take additional steps to ensure safety, like administering a medicine to counteract the blood-thinner or addressing the specific clotting problem.
Equipment used for Wrist Arthrocentesis
The following items are usually used:
* Betadine or chlorhexidine, which are antiseptics used to clean the skin
* Sterile gloves/drape, to maintain cleanliness and prevent infection
* Sterile gauze, used to clean the area or stop any bleeding
* Skin marking pen, for marking the exact spot for the procedure
* Lidocaine, a local anesthetic used to numb the area
* 25-27 gauge sterile needle, a small needle for injecting the anesthetic
* 20-21 gauge sterile needle, a slightly bigger needle for drawing out (aspirating) fluid
* 2-5 ml syringes, used with the needles
* Specimen tubes, used to contain the fluid drawn out for testing
Instead of a usual syringe, a reciprocating syringe could be used. This can make the procedure easier for the doctor because it can be used with one hand. It also tends to cause less pain and can speed up the whole process.
Ultrasound can be really useful too. It can visualize the structures within the joint and detect any fluid buildup there, which can improve the success of fluid aspiration. It also can lead to fewer complications, especially when the joints are smaller.
Who is needed to perform {{Procedure name}}?
Wrist arthrocentesis, a procedure where fluid is removed from your wrist to help with diagnosis or treatment, can be done by healthcare providers either at the emergency room or at a clinic. This task doesn’t need any extra medical staff for help. The person conducting the procedure is fully trained to take care of everything on their own. It’s a fairly straightforward process, so you should not be worried.
Preparing for Wrist Arthrocentesis
Before any medical procedure, it’s important that patients fully understand what will happen and agree to it. This is called informed consent. For this specific procedure, you will be asked to lie flat on your back. Your wrist may be slightly bent forward, and something like a rolled-up towel could be placed underneath it to keep it in the correct position. The doctor will then mark certain spots on your skin to guide them during the procedure. They’ll then clean the area, either with betadine or a similar antiseptic called chlorhexidine.
To help keep you comfortable during the procedure, a local anesthetic might be applied – this is often Lidocaine 1% or 2%. An anesthetic is a substance that causes loss of feeling, so you won’t feel pain in the treated area. However, some doctors might use a topical spray called ethyl chloride instead which simply cools and numbs the skin, or sometimes nothing at all. Rest assured, your doctor will decide what’s best for you in terms of comfort and safety during the procedure.
How is {{Procedure name}} performed
Before cleansing the skin, the doctor will identify the joint space by touching certain spots on your hand. To do this, they will feel the area just below the bony area on the wrist, avoiding the nearby tendons. When ready, they will insert a needle into the upper surface of the hand, aiming it at a right angle to the skin. If the needle happens to hit a bone, it needs to be pulled back and then redirected towards the thumb.
The other approach is similar but uses a different spot for needle insertion. The doctor will locate the joint space by feeling just below the bony bump on the pinky side of your wrist. They will then insert the needle on the top side of your wrist, aiming it towards your thumb.
Once the needle is inside the joint space, the doctor will typically feel a slight give or pop. This is when they will start to withdraw fluid from the joint. They may feel some resistance, which could depend on the size of the needle used, the thickness of the fluid, the amount of fluid, and if there are any clot-like substances present in the fluid. If there’s resistance, moving the needle a bit or pulling it out slightly might help. If they need to inject medication into the joint, they will remove the syringe while keeping the needle in place, and then proceed to inject the medicine. Once they’re done, the needle is taken out and a bit of pressure is applied to where the needle went in. The fluid they removed will be sent to a lab to test for things like cell count, glucose, protein, LDH, lactate, crystals, and culture.
Ultrasound can also be used to help find excess fluid in the joints and perform the procedure. The doctor will use a special machine with a camera to get a view of the joint. A gel-like substance and a clean cover will be used on the camera probe for hygiene. Images from the camera will help the doctor find the spot where fluid has built up. They’ll then insert the needle while watching the ultrasound screen, ensuring the needle goes into the correct spot. As they remove the fluid, they’ll see the size of the fluid pocket decrease on the ultrasound screen.
Possible Complications of Wrist Arthrocentesis
Complications can happen from the medical procedure itself or due to the reaction to the medication injected into the body.
Procedural complications may include unintended damage to nearby body parts such as tendon tearing or damage to local nerves, infections like septic arthritis, pain, bleeding into joint spaces, and return of fluid build-up. Septic arthritis is an infection in a joint that is quite rare but can be serious. We take steps to reduce the risk of infection by maintaining sterile conditions during the procedure. However, if a patient is at a higher risk of infection, they may be given preventive antibiotics to further lower the chance of infection.
Corticosteroids are a type of medication often used in injections to reduce inflammation. But complications can arise from these injections as well. They include the procedural complications mentioned above as well as an allergic reaction, increased blood sugar levels in diabetics, a temporary increase in inflammation (known as a steroid flare), and thinning or weakening of tendons or the skin around the injection site.
What Else Should I Know About Wrist Arthrocentesis?
Arthrocentesis is a procedure where the doctor withdraws fluid from a joint in your body using a sterile needle. This is done either to help relieve pain by draining excess fluid, to inject medication into the joint, or to collect fluid for testing. The doctor will choose a specific technique depending on which joint is being treated, which can help reduce any risks.
The history of your symptoms and a physical examination are useful, but the most accurate way to diagnose septic arthritis (a painful joint infection) is by testing the fluid taken from the joint. This will show elements like white blood cell counts, glucose levels, protein levels and an enzyme called lactate dehydrogenase level (LDH).
High counts of white blood cells or high percentages of a specific type of white blood cell (polymorphonuclear cells, or PMNs) make it more likely that you have septic arthritis. If septic arthritis is suspected, you might be asked to consult with a bone specialist (orthopedist), start antibiotic treatment, and be admitted to the hospital. The bacteria that most commonly causes wrist infections is Staphylococcus aureus, but sometimes no bacteria are found when the fluid is tested.
Crystalline arthropathy is another condition that often affects the wrist joint. It can be diagnosed when doctors find crystals in the joint fluid. The presence of these crystals does not rule out the possibility of having septic arthritis as well, though they can help differentiate between different types of inflammatory joint diseases. In a condition called gout, the joint fluid tests positive for negatively charged crystals of uric acid. In a similar condition called pseudogout, the joint fluid contains positively charged calcium pyrophosphate crystals.