Joint puncture: What is a joint puncture?

Joint puncture consists of inserting a needle into the diseased joint, thanks to which synovial fluid can be withdrawn from its interior, as well as topical medications. It can affect virtually any joint (the most common being the puncture of the knee joint).

How is the joint puncture performed?

During the puncture of the knee joint, the patient lies on his back with straight legs (in the case of other joints, the appropriate position is selected). The puncture area is disinfected with a disinfectant and secured with sterile cloths. The doctor inserts a sterile needle connected to a syringe into the joint. At the moment of passing through the skin and subcutaneous tissue, the patient feels a sting (as a rule, the pain is not very strong and lasts a short time, sometimes it is necessary to anesthetize the skin and joint capsule first).

Dig. Crystals of sodium urate

After injection, the doctor aspirates (draws into the syringe) the synovial fluid (if present). A preliminary, visual assessment of the synovial fluid can often determine whether it is inflammatory or whether there is a suspicion of joint infection; if necessary, further examination of the synovial fluid is performed, e.g., the presence of crystals is assessed under a microscope (e.g. in  gout , see figure). Sometimes, despite the presence of exudate to the joint during the examination, it is not possible to collect the fluid, most often due to fragments of the synovial membrane or articular cartilage that “clog” the needle.

If necessary, and if there is no suspicion of a joint infection, the doctor administers drugs directly into the joint (anti-inflammatory, anesthetic, hyaluronic acid) through the needle, without licking the needle. After removing the needle, the injection site is covered with a sterile dressing that can be removed the same day. Remember not to overload the joint for about two days after the joint has been punctured. Immediately after puncture of the joint, there is usually a significant improvement related to the decompression of the joint and the administration of an anesthetic into it. After a few hours, there may be a slight pain in the joint , which should disappear within a day. If a drug (glucocorticosteroid, hyaluronic acid) is administered to the joint during puncture, after some time the symptoms, such as pain or swelling , are significantly alleviated.pond.

How to prepare for the test?

The examination does not require any special preparation. Tell your doctor if you are allergic (e.g. to anesthetics) and if you are taking medications that reduce blood clotting.

What are the indications for the test?

Joint puncture is a very useful test in the differentiation of the causes of joint pain, especially in patients whose diagnosis cannot be clearly established on the basis of the results of other tests (it is the “gold standard” when gout or joint infection is suspected). It is also a therapeutic procedure that allows the joint to be decompressed from excess fluid (exudate) and to administer anti-inflammatory and anesthetic drugs directly to the affected area. It is also used to administer to the joint a substance that improves the quality of cartilage damaged by the degenerative process (hyaluronic acid). In recurrent, treatment-resistant arthritis, synovectomy (radioisotope or chemical) is performed, which consists in puncturing the joint and injecting into it a substance that destroys its lining, i.e. the synovium,

What are the contraindications for the study?

The joint puncture cannot be performed if there are signs of infection around the joint, e.g. purulent lesions on the skin (this may result in the penetration of microorganisms into the joint). Contraindications to joint puncture are also hemorrhagic diatheses (disorders in the coagulation system) and taking certain medications that reduce blood clotting. Hypersensitivity to the use of individual preparations (e.g. disinfectants, anesthetics) is a contraindication.

Possible complications

Correctly performed joint puncture is a safe procedure. Joint infection is a rare but serious complication, which manifests itself within 1-2 days with severe pain, swelling, redness and warmth of the joint, often accompanied by fever – in this case, you should urgently contact your doctor. Occasionally, there may also be bleeding inside the joint or damage to the cartilage (especially in the event of a hip puncture). If a glucocorticosteroid is administered during puncture, it may cause a transient increase in blood pressure and an increase in blood glucose .