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Elbow arthrocentesis is a procedure performed to aspirate the contents of a joint cavity to evaluate and treat elbow effusion. This activity reviews the indications, contraindications, complications of elbow arthrocentesis and highlights the role of the interprofessional team in the management of patients with elbow problems. Objectives: Identify the anatomical structures of the elbow that one must know before performing arthrocentesis. Describe the technique of performing elbow arthrocentesis. Review the indications for elbow arthrocentesis. Outline the role of the interprofessional team in improving care and improving and outcomes in patients undergoing elbow arthrocentesis. Access free multiple choice questions on this topic.

Elbow arthrocentesis is a procedure performed to aspirate the contents of a joint cavity to evaluate and treat elbow effusion. Arthrocentesis is considered a minor surgical procedure. However, there is always the chance, as with introducing any needle through the skin, for infection, injury to nerves, vessels, tendons, or other connective tissue. Therefore, this procedure should only be performed by health care providers trained in arthrocentesis with a strong understanding of elbow anatomy. Arthrocentesis is commonly used to evaluate the underlying etiology of joint effusion, including infectious, inflammatory, and hemorrhagic causes. Aspiration of the joint space and removal of the contents reduces the fluid pressure in the joint capsule and reduces pain. Additionally, access to the joint space provides the opportunity to inject therapeutic agents in the setting of pain or degenerative joint disease. Of the etiologies above, the most important to diagnose properly is septic arthritis, as cultures are crucial to prompt and adequate treatment.

Even though complications with arthrocentesis are rare, the clinician should take the time to inform the patient of potential complications arising from arthrocentesis. There are two major categories to take into consideration; infectious complications and noninfectious complications. Of the complications, the most feared is septic arthritis.[10]  The frequency of this complication lies somewhere between 1 in 2000 and 1 in 15000. It is best avoided by maintaining a sterile field, minimizing attempts, using single-dose vials, changing to a new needle after drawing up medication before injecting, and preventing the introduction of a needle through cellulitis. The other concerning infection is septic bursitis, which arises when the needle approach travels through a bursa, the olecranon bursa in the case of the elbow, on the way to the joint and is due to direct inoculation from skin flora. Noninfectious complications that arise include tendon rupture, vascular damage, and neurologic damage. All three complications directly result from trauma secondary to the penetrating needle and are more common when injecting glucocorticoids than aspirating. These complications are mediated by carefully planning the approach and identifying the proper anatomical location for insertion and needle travel.  Bleeding management is with tamponade. The patient should also be informed there may be a recurrence of joint effusion until the resolution of the underlying etiology.[1]

Ensuring proper fluid analysis with gram stain and culture is vital to the purpose of arthrocentesis. It is essential to communicate fluid analysis orders with the lab technician and if able to walk the fluid specimens directly to the lab to ensure timely fluid analysis. Clear communication will prevent unnecessary use of long-term empiric antibiotics and improve patient therapy by tailoring the treatment to the proper diagnosis.