Joint puncture is a surgical procedure during which the doctor inserts a needle into the joint bag. It is performed for the purpose of diagnosis or for medical reasons, to reduce the amount of synovial fluid inside.
The essence of the operation
Puncture of the joints is performed by a syringe for 10-20 g, with a needle 5-6 cm in length and 1-2 mm in thickness. Thin needles are used to inject medications into the joint, when there is no need to take liquid from the inside, which allows to significantly reduce the traumatization. For pumping, 2 mm needles are used, and the risk that they will be clogged by solid particles is reduced. The doctor requires exceptionally accurate movements. So, the needle should not enter the articular bag more than 1-1.5 cm, and the slightest oscillation of the tip, when it passes through the synovial membrane, greatly injures it. There is a technique that prevents infection and leakage of the contents of the joint through the hole: the skin needs to be pulled back, than the curvature of the puncture cavity is achieved.
In order to reduce the risks of pathologies, a tight bandage is applied to the leg after puncture, or immobilized with a tire. To prevent complications, the doctor carefully monitors the course of healing, although it is possible and outpatient treatment.
Risks and complications
The synovial membrane that forms the walls of the joint bag is a gentle tissue, the damage of which will be restored for a long time and can cause pathological processes. It is also particularly vulnerable to microbes, so strict antiseptic rules apply. So, the surface of the joint is disinfected in two ways: twice with iodine, followed by alcohol. Here it is necessary to be careful: iodine, penetrating the tip of the needle into the wound, can cause a chemical burn of the shell. Instruments are sterilized by chemical and thermal pathways.
If articular puncture is performed on a healthy joint for the purpose of fence, it reduces the already small amount of synovial fluid. A plentiful amount of punctate can lead to the onset of inflammatory processes and the destruction of cartilage. Also, due to the negative pressure in the bag, osmosis of water and other foreign impurities from the synovial fluid flows through its walls, and a decrease in its amount will adversely affect this process.
For the diagnosis, puncture is performed for:
- Biochemical analysis of punctate, as well as a test for the presence of impurities( pus or blood in trauma and inflammatory processes).
- Using X-rays and drugs that delay the rays, you can get accurate information about the meniscus lesions. In this case, the drug is injected directly into the bag.
A lot of information is obtained not from the laboratory analysis, but directly during the operation. When the fluid starts to flow into the syringe - watch for it. Pay attention to the color, consistency, the presence of blood or purulent impurities. Sometimes novocaine is used for this, which has the property of changing color and viscosity when in contact with foreign biological fluids. Biochemical analyzes of punctate allow to reveal pathologies in metabolic processes occurring in the bag. In addition to mechanical, it performs a nutritional function: it delivers the necessary substances to the avascular cartilage.
Therapeutic operations are performed for:
- Pumping exudate, impurities of blood and pus from the cavity of the joint bag. It is shown in acute inflammatory processes.
- Introduction of various medicines. For example, local anesthesia during surgery and painful manipulation. With inflammation - antibiotics, corticosteroids.
- When hemarthrosis in the joint cavity, there are hematomas that impede the motor function and contribute to the development of infection, therefore, a puncture of the blood from them is indicated.
There is a third indication - the introduction of oxygen into the joint bag. It is used in degenerative-dystrophic lesions of the musculoskeletal system, with shoulder-flap periarthritis, arthrosis of joints or as a means of preventing post-traumatic arthrosis. This method has only one contraindication - the presence of acute purulent-inflammatory processes at the site of the puncture.
Medical oxygen and a specialized instrument are used, although other equipment, such as a device for venting the fallopian tubes, is also possible.
Nuances of puncture of different joints
The technique of the operation is different for different joints because of their structure, the doctor should clearly understand how and where are certain tissues, bones and other anatomical formations in order to maximally pave the way between them without hitting anything superfluous or not facingin the bone.
Puncture of the shoulder joint
It is accepted to distinguish three types of puncture of the shoulder joint: front, back and side. There is no fundamental difference in technique, in all cases, the acromial-clavicular joint serves as a guideline, and the needle is inserted in front, behind and laterally, respectively.
Skin puncture is strictly perpendicular to its surface, after which the direction of advancement changes to the desired one. Entry is carried out until the feeling that the needle "failed" or until a puncture appears in the syringe.
Elbow joint function
Before the beginning of the arm, bend the elbow at an angle of 90 °.The needle is passed into the cavity from behind, between the outer edge of the elbow and the lower edge of the outer epicondyle, directly above the radial head.
If you need to take a puncture from the back turn of the joint, then the needle is pierced through the tendon of the triceps, above the apex of the elbow, and gently guided towards the synovial membrane.
Puncture of wrist joint
Puncture is made on the back surface, at the distal end of the radius, between the tendons of the extensors of the thumb and index finger.
Hip joint puncture
It is performed from the front or from the side. In the first method, the puncture point is in the middle of the line drawn from the upper edge of the large trochanter to the point between the middle and inner third inguinal ligament. The needle is inserted in front, perpendicular to the upper edge of the head of the femur, at the edge of the acetabulum.
In the second method, the needle is introduced from the outside, above the top of the large trochanter, and is advanced in the frontal plane towards the corresponding point on the opposite side.
Puncture of knee joint
Puncture is carried out near the upper edge of the patella, the needle is advanced through the tendon of the quadriceps towards the bone, making rotational movements. It is possible to perform a puncture and the upper, upper and lower edge of the patella.
Puncture of the ankle
Puncture is carried out in front, between the outer ankle and the tendon of the long extensor of the fingers. They are advanced in the posteromedial direction, between the ankle and the lateral surface of the talus.
Below in the video, you can see the procedure for performing a joint puncture.
Knee joint puncture: technique, video
Puncture of the knee joint is called a puncture to remove part of the synovial fluid for further investigation. Sometimes, with a puncture, contrast agents or simple air are injected into the joint to detect possible damage in the form of a meniscus or ligament rupture.
Process of analysis of
From the technical side of the procedure, the puncture can be done in front or on the side of the patella. The most convenient way is considered to be retropatellar access( with a patella dislocation).If a puncture is done in the lower pole, it will be more painful.
The patient lies on a flat surface. His leg should be completely relaxed and not bent at the knee. To puncture the knee joint was carried out correctly, you need to examine the outer part of the patella with the help of palpation. Then the patella is displaced and a needle is inserted under it. With the help of a syringe, all liquid is removed from the joint. Further, washing is carried out with the help of physiological solution. After this, enter the GCS( most often betamethasone and lidocaine) in the volume of one milliliter.
Indications for puncture
Puncture is an important procedure, which is necessary for both diagnosis and therapy.
Therapeutic puncture is usually done, if necessary, to release the knee joint from the hematoma, which slowly dissolves. In this case, penicillin, novocaine, streptomycin, and certain antiseptic solutions for the purpose of washing the joint from the inside are used for analgesia and disinfection.
Puncture in the knee joint should be prescribed in case of accumulation of effusion in the diagnosis of chronic post-traumatic synovitis. In the case of hemarthrosis, after the procedure, a pressure bandage should be applied to the joint.
The physician performs a knee puncture
This procedure can be prescribed for the diagnosis and treatment of arthrosis.
Results after procedure
Puncture of the knee joint is considered to be the most effective way to treat joint pathologies to this day.
If you treat a knee joint from bruising with a simple medication, then it is quite inefficient. When applying ointments, you need to consider that their ability to absorb depends on the characteristics of the human body. Tablets can also give too many side effects on the digestive system.
Special puncture in the knee joint
The more time the hematoma dissolves, the longer the inflammatory process. This can lead to an increase in temperature and worsening of the patient's well-being. Anesthetics will only temporarily relieve symptoms. In such situations, it is better to make a puncture immediately.
Consequences and possible side effects of
If the puncture is performed correctly, taking into account all the rules, the consequences of the procedure are purely positive. Thanks to this manipulation, the patient is more likely to recover.
Intra-articular administration of drugs, especially glucocorticosteroids, has a positive effect on the healing process for arthrosis.
When injected into the joint of betamethasone, the tolerance of the injection is increased, and the effect achieved will be quite long.
No serious side effects from the puncture were observed. Only rare cases of development of contact dermatitis were recorded. This allergic disease manifests itself in the form of rashes on the skin. According to statistics, 2% of the world population is sick. Dermatitis is easy to treat by stopping contact with the allergen.
Puncture of joints - Surgery
Punctures are divided into diagnostic and therapeutic. When puncturing the joints, the features of their anatomical structure should be taken into account. The synovial membrane is a membrane of origin and structure distinct from serous membranes( peritoneum, pleura, pericardium) in that it has neither an epithelial cover nor an endothelial lining on the inner surface facing the cavity. The thickness of it is not the same. It is very sensitive to traumatic, thermal, chemical, infectious effects. High sensitivity of the synovium to infection causes the need for strict compliance with aseptic and antiseptic rules before puncturing or opening the joint cavity and compulsory hermetic sealing. The amount of synovial fluid in the joint cavity is small - up to 4 ml. It is sterile, yellowish-straw color, transparent, has a high viscosity, contains leukocytes and phagocytes, but its bactericidal properties are insignificant. Because of the high specific gravity of the mucopolysaccharides contained in the synovial fluid, it does not diffuse out of the joint cavity, but accumulates in it. To get fluid from joints without pathological processes in them is difficult because of its small amount, high viscosity and negative pressure. In healthy joints, negative pressure is maintained: in the knee joint - 70, - 95 mm of water.p.ankle - 170, - 210 mm of water. Art. Because of the negative pressure, osmosis of the fluid from the synovial membrane and the subchondral plate takes place, from which the articular cartilage is fed. The main functions of joint synovial fluid: a) locomotor - providing, together with articular cartilage, free movement of articulated bone surfaces;b) metabolic - participation in the processes of metabolism between the articular fluid and the vascular bed;c) trophic feeding of the avascular layers of cartilage. With inflammatory phenomena in the joint, the protein content in the synovial fluid increases due to increased vascular permeability. In acute traumatic synovitis, the fluid becomes turbid, the number of neutrophilic leukocytes increases. Damage to the knee joint is accompanied by a violation of biochemical processes, which causes the appearance of highly toxic substances, which enhance the inflammatory process in the joint and support it for a long time.
Indications for diagnostic puncture of joints
- Determine the nature of the contents( exudate, pus, blood).The presence of blood in the damaged joint causes synovitis, intraarticular spikes, degenerative-dystrophic cartilage lesions. In case of traumatic hemarthrosis, adhesive inflammation and stiffness are due not so much to exposure to the spilled blood as to damage to the entire cartilage thickness, the regeneration of which passes with proliferative changes in the connective tissue. Damage to the envelope leads to rapid clotting of the blood, followed by the organization of clots, which in turn lead to the proliferation of the shell tissue and the beginning of obliteration of the joint cavity.
- Set the meniscus lesion in the knee joint with pneumoarthrography: 80-90 cm3 of oxygen at a pressure of 120 mm Hg.p.or radiography after the introduction of 5-10 ml of a 60% solution of urotrast with 0.5% solution of novocaine into the joint.
- Establish the presence of "joint mice", "rice bodies" in the joint cavity.
Indications for therapeutic joint puncture
- to remove blood from hemarthrosis;
- remove the exudate, pus from the joint cavity and inject the antibiotic solution;
- insert a solution of novocaine before reflux;
- for the administration of corticosteroids in combination with lidase in deforming arthrosis;
- to introduce air or oxygen for more sparing destruction of adhesions in the joint with fibrous seams, for gradual distress and restoration of movements.
Technique of joint puncture
Because of the extremely sensitive synovial membrane infection in joint puncture, it is necessary to strictly follow the rules of aseptic and antiseptic.
Before the joint puncture, the puncture site is thoroughly disinfected. It is advisable to use 70 ° alcohol - after lubricating the skin with a 5% solution of iodine recommends removing its traces by double lubrication with alcohol. This is due to the fact that iodine, especially with abundant lubrication, can penetrate into the joint on the needle and cause irritation of the synovial membrane, its chemical burn. In addition, iodine absorbs X-rays and additional shadows may appear on the X-ray that distort the image.
Local infiltration anesthesia. The length of the needle is 5-6 cm. When the oxygen is introduced, the needle should be thin, no more than 1 mm in diameter, otherwise the gas will penetrate into the surrounding soft tissue with the formation of subcutaneous, periarticular or intermuscular emphysema. For the evacuation of blood, pus need a thicker needle. Its diameter should not exceed 2 mm, which is enough to evacuate the effusion with a high content of protein and blood with small clots. When arthroscopy is used trocar.
Skin at the point of injection is shifted to the side. This achieves the curvature of the wound channel made by the needle. After removing the needle, the skin returns to its place. This method prevents the penetration of infection into the joint cavity from the body surface and the leakage of the contents of the joint.
The needle is advanced slowly, trying to determine when its end will pass through the articular bag. At this moment, the hand experiences more resistance, after which the needle moves freely, the doctor feels a sense of failure in the "emptiness."If there is blood in the joint cavity, it will stain a solution of novocaine in the syringe, if pus - novocaine becomes cloudy.
There are various judgments regarding the depth of puncture in joint puncture in the literature. Some believe that the needle should not be moved deeper than 1 cm, others 2-3 cm. If the needle is not inserted sufficiently, it can come out of the joint, and with very deep - damage the articular cartilage. The detached pieces of cartilage can clog the lumen of the needle and make it impossible to inject fluid into the joint, or evacuation from it.
The liquid is aspirated with a 10-20 gram syringe. In the joint with the indications are administered medications. When the needle is removed, the skin displaced before the joint puncture is released, and the channel formed by the needle in the tissues is curved and the contents of the joint do not flow outward, and the infection does not penetrate inside. Place the puncture with alcohol, seal with a sterile napkin. Apply a tight bandage, sometimes a tire for 2-3 days.
Shoulder joint puncture .It is produced from the front, from behind and from the side. For a puncture in front of the patient lay on his back. A groinlike process of the scapula is felt 3 cm below the distal end of the clavicle. The needle is inserted directly under it and is led between the appendage and the head of the humerus from front to back to a depth of 4 cm. Some authors consider the puncture in front to be inefficient due to the mucosa in the small lump.
For puncturing the shoulder joint outside, the patient is placed on a healthy side, the arm is placed along the trunk. The upper part of the head of the humerus is located at the width of the finger from the large tubercle or 1 cm below the outer end of the acromial process. The needle is inserted under the most protruding part of the acromial process and is carried out in the frontal plane through the deltoid muscle.
For a puncture behind the patient lay on the stomach. They feel the posterior edge of the deltoid muscle, where a pit is formed below the posterior edge of the acromial process. Inject the needle and guide it forward to a depth of 5 cm in the direction of the coracoid scapula of the scapula.
Elbow joint function .It is carried out outside or behind. If possible, bend the joint at a right angle. On the outside, the needle is pushed in the "beauty pit" 1 cm downward from the lateral condyle of the humerus. It penetrates into the joint cavity directly above the head of the radius, which rotates during pronation and supination.
For a puncture from behind, the forearm is bent at an angle of 135 °.The puncture of the upper twig of the joint is carried out over the apex of the elbow process, the needle is advanced downward and anteriorly. On the inside, the elbow joint should not be punctured because of the risk of damage to the ulnar nerve and the narrowness of the joint space.
Puncture of wrist joint .Puncture is made from the back surface, becauseon the palmar surface are located a massive layer of muscles and tendons, vascular-neural formations. The forearm is in the position of pronation and flexion. The puncture site is at the point of intersection of the line between the styloid processes of the radial and ulnar bones and the line, which is the extension of the 2nd metacarpal bone. The needle enters the joint between the tendon of the long extensor of the thumb and the extensor of the index finger.
Hip joint puncture .Position of the patient on the back. The point of injection is in the middle of the line, passing from the large spit to the border between the inner and middle thirds of the inguinal ligament. The needle is advanced towards the middle plane of the body. It must be ensured that the needle penetrates into the joint outward from the femoral artery.
From the outside, the needle is held over the top of a large trochanter in the frontal plane on a slightly retracted and rotated inside of the limb. The acetabulum is open downward and outward at an angle of 45 ° to the axis of the body.
Knee joint puncture .It is carried out most easily. This is facilitated by the pathetic displacement of the patella of the joint filled with pathological contents of the patella. The patient is placed on his back, a roll is placed under the knee. The joint can be penetrated with a needle at the midpoint of the patella from the lateral or medial side. The needle is moved parallel to the posterior surface of the patella. For puncture of the upper curvature of the knee joint, the needle is inserted from the lateral side above the patella and moved to a depth of 3 cm under the tendon of the quadriceps femoris muscle.
Puncture of the ankle .Perform at the outer or inner ankle from the front. The patient lies on his back. Stop slightly unbend. At the external ankle, the needle is held in the joint gap between the block of the talus and the ankle 2 cm above the tip of the talus and 1 cm from the inside of it. The needle pierces the tissue between the ankle and the tendon of the long extensor of the fingers. At the inner ankle, the needle is made 1 cm higher and 2 cm lateral to its inner surface. It penetrates between the inner ankle and the tendon of the long extensor of the thumb.
Complications of joint puncture
a) development of infection in the joint( while moving the needle through the tissues do not touch it with your fingers, but support with tweezers);b) rupture of the synovium;c) after the introduction of oxygen can develop: synovitis, subcutaneous emphysema of the hip due to rupture of the upper curvature of the knee joint, embolism of the vessels of the brain. Failures in joint puncture can be explained by the presence of a full synovial septum in the joint( two-chamber joint), hypertrophic folds of the synovial membrane, the presence of a large fat body in the joint.Thank you for reading, you will receive a gift! ( Visited 1 471 times, 1 today)
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