Arthrocentesis (Joint Aspiration)

What is arthrocentesis (joint aspiration)?

Arthrocentesis (joint aspiration) can help your healthcare provider find the cause of swollen, painful joints. It can also provide symptom relief.

Healthcare providers use a thin needle to remove (aspirate) fluid from the affected joint. After aspiration, your provider may inject medications into the joint. These medicines temporarily ease pain and inflammation.

What causes joint pain?

Joints are part of your skeletal system. They are the connection where two bones meet.

Cartilage tissue at the ends of bones helps them move and glide. Synovial fluid cushions and lubricates joints and cartilage. Joint pain, inflammation and swelling occur when something reduces the synovial fluid, cartilage or both.

Conditions that cause joint pain include:

• Arthritis, including osteoarthritis, gout and psoriatic arthritis.
• Autoimmune diseases, including rheumatoid arthritis and lupus.
• Bacterial infections, including Lyme disease.
• Bursitis and tendonitis.

How does arthrocentesis (joint aspiration) work?

Fluid buildup in joints (effusion) puts pressure on the joint. Excess fluid causes pain and swelling. You may find it difficult to bend and move the joint.

Your healthcare provider may drain the fluid and send a sample to a lab. Tests can determine the cause of the fluid buildup.

As a treatment, joint aspiration eases swelling and joint pressure. You should have less pain and find it easier to move after this procedure. Excess fluid often comes back. You may need joint aspiration again.

Healthcare providers typically use arthrocentesis on the:

• Hips, knees, ankles and feet.
• Elbows, shoulders, wrists and hands.

What are joint injections?

After joint aspiration, your healthcare provider may inject corticosteroids into the joint. This anti-inflammatory medication eases pain, swelling and stiffness. The drugs may also slow the return of excess fluid to the joint.

Steroid injections work best for inflammatory conditions like arthritis and tendonitis. Treatment effects last a couple of months. You shouldn’t get more than four injections in the same joint within a year. Steroid overuse can damage the joint and weaken supporting tendons and ligaments.

What is viscosupplementation?

Viscosupplementation is a type of joint injection that specifically treats osteoarthritis. Research on the effectiveness of this treatment shows mixed results. Some people have less pain and improved movement after treatment. But some people see no change.

Your healthcare provider injects hyaluronic acid into a joint (usually the knees). This substance occurs naturally in synovial fluid surrounding joints.

You get one to five injections over a few weeks. It can take several weeks for symptoms to improve. Viscosupplementation may relieve pain and improve mobility for about six months. You can get the treatment again.

How are arthrocentesis (joint aspiration) and joint injections performed?

Joint aspirations and injections take place in your healthcare provider’s office. Your provider may use images from an ultrasound or X-rays (fluoroscopy) to guide procedures.

First, your provider disinfects the skin. For smaller joints, your provider applies a numbing cream to the skin. You may need a local anesthetic to numb a bigger joint section like the hips or shoulders.

During joint aspiration and injection, your provider:

1. Inserts a thin needle into the joint.
2. Attaches an empty syringe to the needle and draws fluid out of the joint (aspiration). Your provider may need multiple syringes to remove all of the fluid.
3. Removes the syringe with the excess fluid and replaces it with a syringe that contains medication.
4. Uses the same needle and entry point to inject medication into the joint.
5. Places a bandage over the treatment area.

What should I do after getting arthrocentesis (joint aspiration) and joint injections?

Depending on the treatment area, you may need to:

• Not lift anything heavy or put weight on the treated area for 48 hours.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) to ease discomfort.
• Your provider may ask you to report back on the immediate and long-term effects of the procedure. This may help in diagnosis.

What are potential risks or complications of arthrocentesis (joint aspiration) and joint injections?

Joint aspirations and injections are relatively safe. Rarely, these complications develop:

• Allergic reaction: Some people are allergic to the anesthetic or the injectable medication. In very rare instances, this can cause anaphylaxis, a life-threatening response.
• Infection: Rarely, people develop infections after getting steroid injections.
• Post-injection flare: An estimated 1 in 50 people develop post-injection flare several hours after getting an injection. It causes joint swelling and pain that subsides in a few days.

How effective are arthrocentesis (joint aspiration) and joint injections?

Joint aspiration and injections can temporarily relieve joint inflammation and pain. The treatments can also improve mobility.

When should I call the doctor?

Call your healthcare provider if you experience:

• Allergic reaction, such as worsening pain or difficulty breathing.
• Fever, chills.
• Signs of infection, such as redness, heat or swelling at the treatment site.
• Worsening pain at the treatment site.

A note from Cleveland Clinic

Joint aspiration can help your healthcare provider determine the cause of joint inflammation and pain. The procedure is also therapeutic. When combined with joint injections, you may get temporary symptom relief. Talk with your provider about whether these treatments are a good option for you.