Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
A joint aspiration is a procedure whereby a sterile needle and syringe are used to drain fluid from the joint. Joint aspiration is typically performed as an office procedure or at the bedside of hospitalized patients. Joint aspiration is medically referred to as arthrocentesis.
What is the purpose of joint aspiration?
Joint aspiration is used to obtain joint fluid for examination in the laboratory. Analysis of joint fluid can help to define causes of joint swelling or arthritis, such as infection, gout, and rheumatoid disease. Joint fluid can be tested for white cell count, crystals, protein, glucose, as well as cultured to detect infection. Each of these laboratory parameters can be helpful in defining the cause of a particular form of arthritis.
Joint aspiration can also be helpful in relieving joint swelling and pain. Removal of joint fluid that is inflamed can also remove the white blood cells within that are sources of enzymes that can be destructive to the joint. Occasionally, cortisone (an antiinflammatory medication) or hyaluronic acid derivatives (a synthetic joint lubricant, approved for use in the knee only) are injected into the joint during the joint aspiration in order to rapidly relieve joint inflammation and further reduce symptoms.
How is joint aspiration performed?
The skin over the joint is cleaned using a liquid, typically an iodine solution (Betadine). Local anesthetic is used in the area of the joint; either by injection, a topical liquid coolant, or both. A needle with a syringe attached is inserted within the joint and joint fluid is drawn back under suction (aspirated) into the syringe. For certain conditions, the doctor will also inject medication into the joint after fluid removal. The needle is then removed and a Band-Aid or dressing is applied over the entry point.
Complications of joint aspiration are uncommon. Possible complications include a reaction to the local anesthetic, local bruising or, minor bleeding into the joint. If cortisone is used, there may be loss of pigment in the skin (a light-colored spot may develop). A rare but serious complication of joint aspiration is infection of the joint (septic arthritis).
If cortisone-related medications (corticosteroids) are injected into the joint, additional uncommon complications include inflammation in the joint as a result of the medication crystallizing, shrinkage (atrophy) or loss of pigment of skin at the injection site, increased blood sugar (worsening of diabetes mellitus), and aggravation of preexisting infection elsewhere in the body. If multiple injections with corticosteroids are given too frequently, it is possible to develop systemic side effects (side effects throughout the body), such as weight gain, puffy face and trunk, and easy bruising. Injection of hyaluronic acid derivatives may cause local inflammation and swelling of the joint due to a reaction to the medication.
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery
"Joint aspiration or injection in adults: Technique and indications"