Wrist (Radiocarpal) Arthrocentesis

imagesProvide evacuation of abnormal collections of fluid from the joint space for synovial fluid analysis

   imagesSeptic arthritis

   imagesCrystal arthropathy


   imagesInflammatory process

imagesDiagnose occult fracture or ligamentous injury

imagesDecrease/relieve pressure in the joint to provide pain relief

imagesUsed to instill medication for treatment and pain relief

imagesUsed to test joint integrity by injecting methylene blue when overlying laceration is present


imagesAbsolute Contraindications

   imagesAbscess/cellulitis in the tissues overlying the site to be punctured (infectious arthritis can often mimic an overlying soft-tissue infection)

imagesRelative Contraindications

   imagesKnown bacteremia

   imagesBleeding diatheses or anticoagulant therapy


imagesPotential for causing infection if not done with proper sterile technique

imagesPain from the procedure (mitigate with local anesthesia)

imagesBleeding from the needle

imagesReaccumulation of fluid may occur

imagesRisk of injuring articular cartilage with needle tip

imagesGeneral Basic Steps

   imagesPatient preparation

   imagesSterilize area

   imagesAnesthetize area



imagesDorsal/Radiocarpal Approach

   imagesPlace the wrist in 20-degree flexion and extend the thumb

   imagesPalpate the dorsal radial tubercle (Lister tubercle) and the extensor pollicis longus tendon as it courses over the distal radius

   imagesPalpate the depression that is distal to the tubercle and on the ulnar side of the extensor carpi radialis brevis tendon

imagesUlnocarpal Approach

   imagesFlex the wrist 20 degrees and palpate the depression between the ulnar styloid process and pisiform bone

   imagesApproach may be problematic due to multiple tendons travel through this region


imagesPatient Preparation

   imagesConfirm landmarks—mark the needle insertion point if needed

   imagesSterilize the area where the needle will be inserted with povidone–iodine solution or comparable skin antiseptic

   imagesWipe injection site with alcohol to avoid introduction of iodine solution into the synovium

   imagesDrape the area with sterile towels

   imagesPlace the wrist in neutral, relaxed position

   imagesApply gentle traction and ulnar deviation to the hand to open the joint space


   imagesUse a 25-gauge needle to infiltrate injection site with lidocaine with epinephrine

   imagesAnesthetize the subcutaneous tissue and a track toward the joint

   imagesAvoid entering the joint space if synovial fluid analysis is desired


   imagesUse a 22-gauge needle attached to a 5- or 10-mL syringe

   imagesFor the radiocarpal approach, direct the needle just distal to the border of the distal radius

   imagesInsert the needle in the depression on the ulnar side of the extensor carpi radialis brevis tendon and between the distal radius and lunate bone (FIGURE 60.1)

   imagesFor the ulnocarpal approach direct the needle between the distal border of the ulnar styloid process and the pisiformis bone (FIGURE 60.2)

   imagesProvide negative pressure on the syringe plunger as the needle is inserted in the joint cavity

   imagesEasy aspiration of fluid confirms proper needle position

   imagesWithdraw needle, apply pressure, then apply clean dressing


imagesIatrogenic infection

imagesIncreased pain

imagesLocalized bleeding

imagesReaccumulation of effusion

imagesInjury to articular cartilage if proper technique is not utilized


FIGURE 60.1 Radiocarpal arthrocentesis. (From Simon RR, Brenner BE. Emergency Procedures and Techniques. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:239, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Wrist (Radiocarpal) Arthrocentesis
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