Why Is Wrist Arthrocentesis Performed?

Wrist arthrocentesis is a procedure to remove or aspirate fluid from the wrist joint through a needle for diagnostic and treatment purposes.

Wrist arthrocentesis is performed in patients in the below conditions:

• To reduce pain and swelling from the joint
• To inject medications at that joint
• To diagnose conditions related to pain, swelling and infection (septic arthritis, gout, arthritis, etc.) 
• To remove the synovial fluid for diagnostic and treatment purposes

Wrist arthrocentesis is not performed when a patient has

• Cellulitis (infection on the skin).
• Dermatitis or psoriasis (lesions on the skin).
• A history of bacteremia (severe bacterial infection).
• Bleeding disorders.
• Unstable joint or fracture.

It is also avoided in patients who are on anticoagulant medications (Warfarin).

Wrist arthrocentesis is usually done under local anesthesia, and the procedure is completed in less than 45 minutes.

• The area of the wrist is cleaned with betadine.
• Lidocaine is injected first on the skin and then into the deeper tissues.
• Once anesthesia is given, patient vitals are monitored.
• The patient is usually kept in a normal sleeping position with their palms open and flexed.
• Usually, the needle is inserted through the upper side of the wrist just away from the radial bone.
• The needle is usually inserted perpendicular to the skin. 
• If the needle is touching the bone, the needle is pulled back, and it may be redirected slightly toward the thumb.
• Sometimes, the surgeon may also use the ulnar bone side approach. Keeping the wrist in the same relaxed position, the joint space can be identified by palpating just away from the ulnar joint. 
• A 22-gauge needle is usually used for the procedure.
• The surgeon may also use bedside ultrasonography for joint aspiration to localize the optimal site for needle placement.
• A pop or give way is felt as the needle enters the joint.
• Sufficient fluid and any infection are aspirated through the needle.
• If the fluid cannot be withdrawn, rotating the needle, withdrawing it slightly or even reinjecting a little of the fluid often unclog the needle and allow additional fluid to be withdrawn. 
• After the procedure is done and the sample is taken, the needle is withdrawn. 
• In therapeutic cases where injections are to be given, the only syringe is removed, keeping the needle secure in the place, and the desired medication is injected.
• At the end of the injection procedure, the needle should be swiftly withdrawn, and light pressure should be applied on the needle site on the skin.

The risks involved in wrist arthrocentesis include the following:

• Wrist pain
• Swelling near the injected site
• Septic arthritis (infection)
• Nerve, bone or tendon injuries due to misplaced needles