A joint puncture involves opening the cavity of a joint with a needle. It is used to insert drugs or to aspirate fluid.
What is joint puncture?
A joint puncture involves opening the cavity of a joint with a needle. It is used to insert medicine or to aspirate fluid. Joint puncture refers to a medical procedure in which the attending physician punctures the joint capsule with a needle. In this way, the physician gains access to the joint cavity. The purpose of joint puncture is to introduce medical substances or to aspirate fluid from the joint. In principle, it is possible to puncture all larger joints. The most common joint punctures include knee joint puncture, facet joint puncture, and hip joint puncture.
Function, effect, and goals
Joint puncture can be performed for both diagnostic and therapeutic purposes. It is usually done when there is an accumulation of fluid inside the joint. Physicians refer to such an accumulation of fluid as a joint effusion. Joint effusions are usually caused by injuries or diseases of the affected joint. This can be fresh meniscus damage or cartilage damage in the knee. Furthermore, diseases of the joint due to rheumatism, infections or gout often occur. A distinction is made between bloodless and bloody effusions. Thus, a mixture between synovial fluid and blood is possible. In a healthy joint, on the other hand, it is a viscous and clear puncture. By performing a joint puncture, the physician is able to detect changes. Following the puncture, a more detailed analysis of the joint fluid is carried out in a laboratory. When performing a joint puncture, a distinction must be made between a diagnostic and a therapeutic application. During a diagnostic puncture, the possible cause of a joint effusion or swelling can be determined. In this way, the physician determines whether inflammation is present or whether there is bleeding in the joint. Traces of blood, for example, can indicate a capsule-ligament injury or an injury involving bone. If the puncture is cloudy-yellowish, this is considered an indication of a rheumatic disease. In the case of a turbid-thin consistency, a purulent joint infection may be present. If the joint fluid is colorless, there is often cartilage or meniscus damage. If the fluid takes on a raspberry-red color, this indicates syphilis (lues). Therapeutic joint puncture is also important. This is primarily used in the case of pronounced joint effusions. With its help, pain can be quickly alleviated and the joint relieved. Puncture is also extremely important if the patient suffers from a hematoma in a joint. In this case, a larger amount of blood is punctured, because otherwise cartilage damage can occur, which in turn leads to painful inflammation within the joint. In the case of an already existing joint inflammation, an exclusive therapy with punctures is not considered useful. Thus, the positive effect of relief with this procedure is too short. For this reason, the physician injects the patient with cortisone into the diseased joint. This procedure usually quickly relieves the pain effectively. However, no bacterial infection must be present. During the puncture, other medications such as cartilage-building hyaluronic acid, painkillers or contrast media can also be injected. For example, a contrast agent is administered before a computer tomography (CT) or magnetic resonance imaging (MRI). This gives the doctor the opportunity for a better assessment of the joint. When performing a joint puncture, it is important to ensure that it is free of germs. Thus, the puncture should ideally take place in an operating room area. Before the medical treatment is performed, the joint to be treated is thoroughly disinfected. It is also covered with sterile drapes for protection. To cover the puncture site, the physician, wearing protective surgical clothing, uses a slit drape. Cannulas are used, which have different lengths and diameters depending on the need. In most cases, the patient lies on his or her back during a joint puncture. The puncture is usually performed under ultrasound guidance.This involves inserting a cannula into the joint, through which the doctor either aspirates fluid or injects a drug.
Risks, side effects, and dangers
Because little pain is felt when performing a joint puncture, local anesthesia is needed in only a few cases. General anesthesia can usually be avoided. A longer stay in hospital is also not necessary. There are usually no major risks or complications associated with joint puncture. In some patients, however, the occurrence of bleeding or injury to the joint structures is within the realm of possibility. Allergic reactions may also occur. This usually occurs when the patient receives certain medications as part of the puncture. Typical signs are a skin rash, itching and swelling. In the worst case, this can lead to circulatory or renal failure. If sufficient sterility is not ensured, there is a risk of joint infection. However, if the procedure is performed professionally and sterilely, this risk is minimal. Furthermore, damage to blood vessels and nerves is conceivable. There is also the possibility of mechanical damage to the joint by the penetrating cannula. The use of the cannula can also lead to the penetration of bacteria into the joint, which in turn results in an infection. There are only a few known contraindications to joint puncture. For example, it should not be done if there are skin lesions, skin diseases or an infection at the puncture site. Another possible contraindication is a massive change in blood clotting.
Typical and common joint diseases
- Osteoarthritis
- Joint inflammation
- Joint pain
- Joint swelling
- Rheumatoid arthritis
