Part One: Tapping the Wrist

​The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for septic arthritis. Use ultrasound to confirm the proper aspiration site and the angle for the needle during arthrocentesis. This patient had multiple bandages on his fingertips from blood glucose testing, providing an entry for infection and increasing the chance of developing a septic joint.Joint aspirations carry minimal risk when done properly. They may even have lower morbidity and mortality than those who undergo surgical debridement. (J Bone Joint Surg Am. 2015;97[7]:558; The wrist is complex, and our video highlights the anatomy using ultrasound (US). We suggest a static approach to determine if there is a collection of fluid or an abscess, and then consider US-guided needle aspiration of the joint.Watch a video of Walter Schlech, MD, the ultrasound director at Berkshire Medical Center in Pittsfield, MA, using ultrasound to identif...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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