Puncture articular effusion

If a patient suffers from a joint effusion, in some cases it is useful to puncture the effusion. This is done under sterile conditions by puncturing the effusion with a thin needle to remove fluid via a syringe or inject medication. Puncturing is useful in three ways.

If the exact cause and extent of the joint effusion is in question, it can be punctured for diagnostic purposes. A few milliliters of fluid are removed so that it is quickly visible whether blood or pus is present. Furthermore, this sample can be microbiologically examined and possibly a pathogen can be identified.

On the other hand, a joint effusion can be punctured with therapeutic intent. In many cases, the fluid in the joint exerts a painful pressure and cannot be absorbed by the body, so that the joint effusion is removed from the joint space by puncture to relieve the pressure. Especially when pus makes up a large part of the fluid, puncture helps to reduce the inflammation.

In addition, doctors puncture an articular effusion in order to apply medication directly to the affected area. This is often done with cortisone. However, the indication for puncturing an articular effusion should always be narrowly defined, as the puncture itself can allow pathogens to enter from outside and cause inflammation. Therefore, special attention must be paid to sterility and care.

Prognosis

If the joint effusion had a simple cause such as a one-time trauma, it usually disappeared after the joint puncture and does not return. Sometimes, however, several punctures are necessary. Then the affected person is symptom-free again.

In patients with underlying disease, the prognosis of a joint effusion depends mainly on the correct therapy of this underlying disease. If, for example, haemophilia, psoriatic arthritis (inflammation of the joint due to psoriasis) or arthrosis remains undetected, the patient may initially be completely free of symptoms for a short time after the effusion has been relieved, but in the course of the disease it is highly probable that he will again suffer from a joint effusion and possibly other problems. Therefore: The cause of the effusion in the joint must always be identified in order to prevent its further occurrence.

Articular effusions of the shoulder are usually caused by inflammation of the shoulder joint. Especially in older people, degenerative changes can be the cause of shoulder inflammation. These are caused by wear and tear.

Here, for example, calcification of tendon attachments or tears and fraying of the tendons can occur. Excessive irritation can also lead to inflammation of the tendon. However, minor accidents can also cause major damage to the shoulder even in older people with previously damaged shoulder joints.

For example, bony fractures or ruptures of the muscle tendons can also trigger an inflammation. An inflammation of the bursa can also trigger an inflammation of the shoulder joint. Inflammation of the shoulder joint can occur, for example, in septic inflammation, where the inflammation has a different origin in the body and has spread to the shoulder region.

The pathogens causing the infection can re-colonize in the blood and trigger an inflammation.This is most common in cases of delayed pneumonia and a weakened, suppressed immune system. A particularly weakened immune system is found in cancer patients, elderly patients, pregnant women, or in patients with immune disorders. Side effects of septic inflammation are pain in the shoulder region, redness, swelling, fever, feeling of illness and effusion.

The presence of an underlying rheumatic disease can also lead to inflammation of the shoulder joint and thus to effusion. A participation of the shoulder joint as an accompanying illness occurs with 50-90% of the rheumatism patients. The patients usually have recurring swellings, effusions and pain in the shoulder joint.

Initially, typical signs of inflammation can often be seen in the presence of an effusion, such as overheating, swelling and redness. During palpation, the patient would not tolerate this for long, because he would probably express too much pain, and there is also a severe restriction of movement. Because of the severe restriction of movement, inflammation of the shoulder joint is also known as “frozen shoulder” or shoulder joint stiffness.

Therefore, it is better to diagnose with the help of equipment. An ultrasound device can usually make an effusion clearly visible. If you are unsure of the underlying disease or want to determine the exact cause, you can then puncture the effusion under ultrasound control.

The puncture is done with a fine hollow needle. The fluid can then be tested for pathogens such as bacteria or viruses, rheumatoid factors, cells, etc. In addition, an X-ray can be taken to assess the extent of the shoulder joint damage.

Sometimes a magnetic resonance tomogram is necessary. The treatment consists of treating the underlying disease. In the case of septic inflammation, this means, on the one hand, fighting the underlying disease in order to get the inflammation out of the shoulder.

This is done by means of a surgical procedure and thus cleaning and irrigation of the joint. In addition, antibiotic therapy should be initiated. With a rheumatic basic illness there are special antirheumatic drugs which can be used and even the use of Kortison.

Depending upon infestation of the joint by the rheumatic illness even an operational reorganization up to an artificial joint replacement can be necessary. Conservatively one can use pain-killing and anti-inflammatory medicines. These include the painkiller class of non-steroidal antirheutics such as Ibuprofen, Diclofenac or ASS.

The drugs can be administered orally or by injection into the shoulder joint. Surgical treatment is always performed using the keyhole technique in the form of a joint endoscopy (arthroscopy). An effusion on one or more fingers can have various causes.

On the one hand, there are inflammatory diseases that can contribute to swelling. The inflammation of the joint is also called arthritis, which itself can have various causes. The most common cause of arthritis is rheumatoid arthritis, whereby the fingers are very often affected with both hands.

Here, the joint effusion is usually accompanied by other signs of inflammation such as overheating, redness, pain and functional limitations. After resting, a feeling of stiffness usually results, which gradually disappears again through movement. In the course of the disease, rheumatic nodules can also form on the fingers.

However, there are also other causes of joint inflammation. Because an infection with pathogens such as bacteria or viruses can also trigger an inflammation of the joints. In addition there are also different metabolic illnesses, like gout, which can cause joint inflammation, or also autoimmune diseases.

Autoimmune diseases with frequent joint inflammation include: rheumatoid polyarthritis (rheumatism with joint inflammation in several joints), psoriasis (a rheumatic disease with additional skin infection as psoriasis) and ankylosing spondylitis (also a rheumatic disease, where the spine is particularly affected) or scleroderma (here, the skin is also affected). Degeneration of the joints (arthrosis) in the fingers can also lead to joint effusion and also to inflammation. Due to the wear and tear of the joints, friction causes irritation, which can trigger inflammatory reactions such as joint effusion.

Articular effusion in the fingers can also be caused by trauma. In addition to fractures and bruises, the fingers are often torn apart by a so-called capsule tear. The capsule normally provides the necessary stabilization of the fingers and is often damaged during handball sports, such as volleyball, handball, basketball or martial arts.A jerky impact can lead to overstretching or even rupture of the capsule.

If the capsule is torn, it is recommended to cool the area first of all, so that the finger swells a bit. In addition, painkillers can also be given. The capsule rupture is usually recognized by a functional impairment of the fingers with swelling and throbbing pain.

By palpation and light movement the doctor usually recognizes this immediately. In addition, an X-ray is usually taken to rule out possible fractures. As treatment, a bandage is applied, which is worn for about two weeks.

Due to its size, the hip is the most stressed joint in the body. Therefore, a joint effusion can also occur here. In this case, walking is difficult and mobility in the hip is limited.

The joint effusion is not as visible on the outside of the hip as on the knee or ankle, but it also causes pain, especially when moving. These can radiate into the lumbar spine. The main causes of articular effusion in the knee are degenerative, i.e. wear-related and inflammatory diseases.

Activated coxarthrosis is primarily responsible for joint effusion. This is a wear and tear of the joint surfaces in the hip. The disease occurs mainly at an advanced age.

The joint effusion is caused by inflammation of the synovial membrane, which leads to increased production of synovial fluid. Other typical causes are trauma and overloading of the joint, especially during sports activities. Children and adolescents often suffer from coxitis fugax, an inflammation of the hip with joint effusion.

First, the general mobility of the hip is examined and the hip is palpated. In addition to the limited mobility, a pressure pain above the hip joint can usually be detected. Then, in the case of articular effusion in the hip, equipment is used to detect the articular effusion.

The first step is ultrasound, which can non-invasively visualize the joint space by an experienced examiner and allow the amount of fluid in the joint to be estimated. If this examination is not sufficient, an X-ray or MRI may be appropriate. Furthermore, in some cases a diagnostic puncture is indicated in case of joint effusion.

In addition to relieving the joint, this can be used to determine whether the fluid in question is serous fluid, pus or blood. In the beginning, an attempt is made to treat the joint effusion in the hip conservatively. The most effective measures here are elevation, cooling and protection.

Non-steroidal anti-inflammatory drugs such as diclofenac or ibuprofen can be given as a support. In case of bacterial detection, antibiotics are indicated. Another option is the injection of cortisone directly into the joint. Cortisone has an anti-inflammatory and decongestant effect, but this measure is controversial because of the risk of infection. Surgical therapies represent the last option in the case of joint effusion of the hip, but are indispensable in the case of damage to structures.