Part Two: Mastering Wrist Arthrocentesis

​We discussed the initial approach to the red, hot swollen wrist joint last month, and this month we focus on arthrocentesis of the joint with a full video of the procedure, including ultrasound and joint aspiration.A swollen, painful wrist that is hot to the touch with scant erythema is concerning for septic arthritis. The patient had multiple Band-Aids on his fingertips from blood glucose testing for diabetes, which increased his chances of having a septic joint with the punctures serving as an entry site for infection. Photo by Martha Roberts.The ProcedureIdentify the swollen joint, review the differential diagnosis, and perform arthrocentesis using the static ultrasound-guided technique to complete joint aspiration.The PauseThree views of the wrist in a new presentation of a swollen joint with or without a straightforward history may be of significant value. Radiographs may show a foreign body, a fracture, or an effusion. Patients may not be the best historians, and they rely on us to rule out serious pathology. We suggest obtaining plain films on all swollen wrists at the time of initial presentation.Three-view x-ray images of the right hand of a 64-year-old man with diabetes showing soft tissue swelling. The final diagnosis was septic arthritis of the wrist. Photos by Martha Roberts.The ProcedureComplete plain film radiographs, three views.Consider PO medication before the patient goes to x-ray, such as acetaminophen or an anti-inflammatory. Plain films and equipment ...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs