What Is Elbow Arthrocentesis?

Arthrocentesis is a procedure to remove fluid from a joint (synovial fluid) using a sterile needle and syringe. Your doctor may perform this procedure if your joint has a limited range of motion because of pain and swelling. Arthrocentesis, when properly performed, may alleviate pressure and relieve joint pain. 

Elbow arthrocentesis removes fluid from the elbow joint cavity to diagnose the cause of elbow swelling and underlying diseases.

Elbow arthrocentesis is a minor procedure that involves removing the fluid (synovial fluid) from the elbow joint cavity through a needle (aspiration) The aspirated fluid is then sent to a lab for further analysis. This aspirated fluid helps to diagnose the cause of elbow swelling and underlying diseases.

Elbow arthrocentesis is usually recommended in patients who have:

• Severe injury
• Hemarthrosis (Blood collection in joints)
• Septic arthritis (Infection of elbow joints)
• Excessive joint fluid collection (inflamed synovial fluid and synovial fluid analysis for diagnosis)
• Swelling of the elbow joint (Gout or rheumatologic disorders)

Elbow arthrocentesis is not suitable for the following conditions:

• Severe skin infection (Cellulitis and known cases of bacteremia)
• Overlying skin lesions (dermatitis or psoriasis)
• Bleeding disorders
• Patients who are on anticoagulation medication (heparin, aspirin)

Patients are usually discharged on the same day after the procedure. Local anesthetics, such as lidocaine, typically wear off within two to four hours, so patients may feel an increasing pain shortly after the procedure. 

Doctors usually give painkillers and anti-inflammatory medications for three days. It is common to have mild soreness for a day or two after the procedure. The doctor may recommend periodically icing the joint and wrapping it with a bandage to prevent swelling.

Patients usually recover well after the third day of the procedure. 

Elbow arthrocentesis is usually done under local anesthesia. 

• The skin around the puncture site is cleaned with an iodine solution.
• Once anesthetized (numbed), a 1.5-inch-long needle with an 18-22 gauge is attached to a 5- to 10-mL syringe is advanced into the joint space with aseptic precautions. The needle is simultaneously retracted to observe the blood return.
• Once the joint space is accessed, the synovial fluid, blood, or infectious material is aspirated. With the needle held in place, multiple syringes may be used to aspirate all the contents of the joint.
• Occasionally, glucocorticoid may be injected before withdrawing the needle from the joint space to prevent the relapse of swelling.
• The needle is withdrawn and the bandage is applied at the area. The collected fluid is then sent to a lab for further analysis.
• The procedure is usually completed within an hour.

Besides relieving pain and improving joint movement, arthrocentesis is a valuable procedure to determine the etiology of joint effusion, including infection, inflammation, or other factors. This helps the doctors to diagnose and treat the patients accordingly.

The possible risks following elbow arthrocentesis include:

• Bleeding
• Swelling
• Joint infection
• Negative reaction to anesthesia (headache, nausea, and drowsiness)
• Infection at the needle entry site

Patients undergoing elbow arthrocentesis experience mild pain after the anesthesia wears off. The doctor may prescribe painkillers for reducing the pain and making the patient more comfortable.

Apart from painkillers, doctors recommended anti-inflammatory medicines and antibiotics as a precautionary measure after the procedure.