Knee arthrocentesis and glucocorticoid injection. A 33-year-old woman, who had had rheumatoid arthritis for several years, had morning stiffness and oedema of the left knee. The ultrasound picture shows the form and size of the synovial cavity (about 1 cm x 2 cm, best puncture site laterally on the knee, at the border between the middle and upper third of the patella). This patient has a notably thick synovial membrane and rather scanty synovial fluid. Mark the puncture site, carefully cleanse the skin, and anaesthetize the whole puncture route, as necessary, using a thin needle. Normally, local anaesthesia is not necessary because the puncture needle is thin but if it is to be used and another needle is to be used for the aspiration, the puncture site should be changed slightly to reduce the risk of infection. The whole procedure must be carried out under sterile conditions. Use your fingers to press the fluid from the opposite side of the patella and from the suprapatellar recess to the aspiration site. Insert the aspiration needle slowly into the joint cavity until fluid enters the syringe. In this case, 20 mg triamcinolone was injected into the joint cavity Intra-Articular Steroids in the Knee for Rheumatoid Arthritis. Cover the puncture site with self-adhesive sterile dressing; it should be kept dry until the end of that day. Any extra strain on the leg should be avoided until the following day (sick leave).
Video and text: Ilkka Kunnamo and Sakari Pohjonen
Primary/Secondary Keywords