Joint puncture

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With a joint puncture, the doctor pokes a needle into the cavity of a joint to suck out fluid or inject medication. Read everything about the process of the joint puncture, when it is necessary and what risks it entails.

What is a joint puncture?

A joint puncture is the process of inserting a needle into the joint cavity. With this needle, the doctor can on the one hand suck fluid out of the joint and have it examined, on the other hand he can inject medication into the joint space (injection). Many joints allow the puncture (knee, hip, shoulder, elbow, finger and toe joints, etc.), which can usually be performed on an outpatient basis.

When do you perform a joint puncture?

The joint puncture serves both the diagnosis and the therapy of various, especially orthopedic diseases. Diagnostic uses of the joint puncture are:

• Extraction of synovial fluid
• Introduction of contrast media for imaging diagnostics (X-ray, computed tomography, MRI)

Therapeutically, the doctor can inject medication, for example cortisone, or painkillers into the joint. On the other hand, he can relieve a joint swollen by an effusion by sucking off effusion fluid.

In the case of injuries, inflammations or infections of the skin in the area of ​​the puncture site, however, the doctor should avoid a joint puncture if possible so as not to carry bacteria into the joint.

What do you do with a joint puncture?

If the doctor wants to puncture a joint, for example the knee, he first cleans the puncture site with a germicidal (antiseptic) agent. Hair in the area of ​​the puncture site is removed with a razor blade. Local anesthesia is rarely necessary.

The doctor then covers the joint and its surroundings with a sterile cloth. The cloth has a hole over the planned puncture site (perforated cloth). This is important so that bacteria from the environment cannot get into the joint.

Then the doctor inserts a hollow needle into the joint. Larger joints can be punctured using various access routes: the doctor, for example, can puncture knee joints from the front as well as from the side below the kneecap. Sometimes he uses an ultrasound machine to check the correct position of the needle.

He can then suck off any fluid present in the joint through the hollow needle. If it is a therapeutic joint puncture, he injects the drug into the joint cavity.

Diagnostic joint puncture: assessment of the fluid obtained

The sample obtained during the joint puncture is called a puncture. The doctor can assess this both with the naked eye (macroscopically) and with special laboratory analyzes. Healthy synovial fluid is straw yellow, relatively thin and clear. Examples of pathological findings are:

• Bloody synovial fluid when the joint capsule or ligaments are injured or when there are coagulation disorders
• bloody synovial fluid with fat eyes in injuries of the bone up to the marrow cavity
• serous, particularly thin joint fluid for degenerative joint damage
• Cloudy synovial fluid in rheumatic diseases or purulent joint infections
• yellow-milky synovial fluid in gout

What are the risks of a joint puncture?

The joint puncture is hardly more painful than a normal blood sample, and when medication is introduced, a temporary feeling of pressure can arise.

The most feared complication is the introduction of pathogens into the joint cavity. These often cause purulent inflammation there, which, if left untreated, can lead to destruction of the joint, inflammation of the bone marrow and also to sepsis.

When administering medication, intolerance reactions can occur, which are accompanied by swelling, itching, rashes and, in extreme cases, circulatory failure.

What do I have to consider after a joint puncture?

After the joint puncture, the doctor will put a sterile wound dressing on you. Make sure that it does not get wet while washing. You can use special shower plasters for this, for example. If you feel any discomfort in the punctured joint, you should urgently consult your doctor. Overheating, redness, fever or pain can be signs of an infection that needs to be treated as soon as possible.

How long you have to take care of yourself depends on the punctured joint: For example, after a knee joint surgery, it is advisable to keep the leg still for four to six hours. Ask your doctor who performed the joint puncture.

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