Algorithmic Approach to the Use and Interpretation of Synovial Fluid Aspiration and Analysis - Flowchart
Algorithmic Approach to the Use and Interpretation of Synovial Fluid Aspiration and Analysis - Flowchart
«Flowchart»

INTERPRETATION OF SYNOVIAL FLUID ASPIRATION

Strongly consider synovial fluid aspiration and analysis if there is


Monarthritis (acute or chronic)
Trauma with joint effusion
Monarthritis in a patient with chronic polyarthritis
Suspicion of joint infection, crystal-induced arthritis, or hemarthrosis

INTERPRETATION OF SYNOVIAL FLUID ASPIRATION

Strongly consider synovial fluid aspiration and analysis if there is


Monarthritis (acute or chronic)
Trauma with joint effusion
Monarthritis in a patient with chronic polyarthritis
Suspicion of joint infection, crystal-induced arthritis, or hemarthrosis

INTERPRETATION OF SYNOVIAL FLUID ASPIRATION

INTERPRETATION OF SYNOVIAL FLUID ASPIRATION

Strongly consider synovial fluid aspiration and analysis if there is


Monarthritis (acute or chronic)
Trauma with joint effusion
Monarthritis in a patient with chronic polyarthritis
Suspicion of joint infection, crystal-induced arthritis, or hemarthrosis


Monarthritis (acute or chronic)
Trauma with joint effusion
Monarthritis in a patient with chronic polyarthritis
Suspicion of joint infection, crystal-induced arthritis, or hemarthrosis

Consider


Trauma or mechanical derangement
Coagulopathy
Neuropathic arthropathy
Other

Consider


Trauma or mechanical derangement
Coagulopathy
Neuropathic arthropathy
Other

Consider


Trauma or mechanical derangement
Coagulopathy
Neuropathic arthropathy
Other


Trauma or mechanical derangement
Coagulopathy
Neuropathic arthropathy
Other

Inflammatory or noninflammatory articular condition

Inflammatory or noninflammatory articular condition

Inflammatory or noninflammatory articular condition

Consider noninflammatory articular conditions


Osteoarthritis
Trauma
Other

Consider noninflammatory articular conditions


Osteoarthritis
Trauma
Other

Consider noninflammatory articular conditions


Osteoarthritis
Trauma
Other


Osteoarthritis
Trauma
Other

Consider inflammatory or septic arthritis

Consider inflammatory or septic arthritis

Consider inflammatory or septic arthritis

Crystal identification for specific diagnosis


Gout
Pseudogout

Crystal identification for specific diagnosis


Gout
Pseudogout

Crystal identification for specific diagnosis


Gout
Pseudogout


Gout
Pseudogout

Possible septic arthritis

Possible septic arthritis

Possible septic arthritis

Probable inflammatory arthritis

Probable inflammatory arthritis

Probable inflammatory arthritis

End

End

End

Consider other inflammatory or septic arthritides


Gram stain, culture mandatory

Consider other inflammatory or septic arthritides


Gram stain, culture mandatory

Consider other inflammatory or septic arthritides


Gram stain, culture mandatory


Gram stain, culture mandatory

Yes

Yes

Yes

No

No

No

Is the WBC >2000/µL?

Is the WBC >2000/µL?

Is the WBC >2000/µL?

Yes

Yes

Yes

No

No

No

Is the % PMNs >75%?

Is the % PMNs >75%?

Is the % PMNs >75%?

Yes

Yes

Yes

No

No

No

Are crystals present?

Are crystals present?

Are crystals present?

Yes

Yes

Yes

No

No

No

Is the WBC >50,000/µL?

Is the WBC >50,000/µL?

Is the WBC >50,000/µL?

Yes

Yes

Yes

No

No

No

PMNs, polymorphonuclear leukocytes; WBC, white blood cell count.

PMNs, polymorphonuclear leukocytes; WBC, white blood cell count.

PMNs, polymorphonuclear leukocytes; WBC, white blood cell count.

Analyze fluid for


Appearance, viscosity
WBC count, differential
Gram stain, culture, and sensitivity (if indicated)
Crystal identification by polarized microscopy

Analyze fluid for


Appearance, viscosity
WBC count, differential
Gram stain, culture, and sensitivity (if indicated)
Crystal identification by polarized microscopy


Appearance, viscosity
WBC count, differential
Gram stain, culture, and sensitivity (if indicated)
Crystal identification by polarized microscopy Analyze fluid for

Is the effusion hemorrhagic?

Is the effusion hemorrhagic?

Is the effusion hemorrhagic?