Presentation
In patients presenting with atraumatic joint pain and swelling, diagnosis is typically made by synovial fluid analysis. Management of an acute suspected hip joint arthritis can present a challenge to the emergency physician (EP). [ncbi.nlm.nih.gov]
Ultrasound is a useful tool to evaluate and initiate diagnostic and therapeutic measures for patients presenting with hip pain suspicious for effusion. [mdedge.com]
Diagnostically, arthrocentesis is indicated to rule out septic arthritis in individuals presenting with a single or several inflamed joints. [nejm.org]
Entire Body System
- Fever
Your doctor will go over some problems, like: Infection Bleeding Increased pain Things that may raise the risk of problems are: Infections on the skin Recent fever or infection Bleeding problems Use of blood thinners What to Expect Prior to Procedure [lahey.org]
Emergency Medicine Arthritis with…Arthritis with…Arthritis with…Arthritis with… ……low-grade feverlow-grade fever anyany inflammatory arthritisinflammatory arthritis ……high fever, chillshigh fever, chills septic arthritisseptic arthritis ……kidney [slideshare.net]
Septic arthritis causes symptoms like joint pain, swelling, redness, and fever. It is a serious illness that requires prompt diagnosis and treatment. [wakehealth.edu]
- Asymptomatic
[…] and Esthetic Surgery Clinic, Istanbul Okmeydanı Research and Training Hospital, Okmeydanı, Istanbul, Turkey. [email protected] Abstract Management of temporomandibular joint (TMJ) disorders presenting with pain, restricted mouth opening, or simply asymptomatic [ncbi.nlm.nih.gov]
Gonococcal septic arthritis is more common in women, especially during pregnancy or after menstruation, because women with sexually transmitted gonorrhea infections are more likely to be asymptomatic. [veteriankey.com]
- Weight Loss
You have lost 10 pounds (4.5 kilograms) or more without trying (unintended weight loss). Your joint pain lasts for more than several days. You have severe, unexplained joint pain and swelling, particularly if you have other unexplained symptoms. [mountsinai.org]
Respiratoric
- Aspiration
Aspiration in cases of hemarthrosis can prevent adhesions. Aspiration can be performed immediately prior to injecting intra-articular medications. [boneandspine.com]
What is the recovery time for joint aspiration (arthrocentesis)? There is no recovery time required after joint aspiration. [medicinenet.com]
A "blind" aspiration was performed on each group. The volume of aspirated joint fluid (in milliliters) (V(1)) was recorded for each knee. Each knee was then checked by ultrasound immediately after aspiration. [ncbi.nlm.nih.gov]
Synovial fluid can be aspirated from a joint cavity using the medial or lateral approach. And insertion sites include suprapatellar and parapatellar. [simulab.com]
Medial approach to aspiration of ankle joint. Medial approach to aspiration of knee joint. Anterior approach to aspiration of glenohumoral joint. Point where coracoid can be palpated is marked with "C." Approach to aspiration of the wrist joint. [emedicine.medscape.com]
Jaw & Teeth
- Bruxism
Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. [ncbi.nlm.nih.gov]
It is essential therefore to treat the possible causes such as clenching or bruxism with the splint that is a complementary therapy. It is also important to begin the drug therapy and physiotherapy. [sembroniomaxillo.com]
Bruxism is thought to be one of the major contributing factors to the etiology of TMJ. [amsjournal.com]
Ears
- Tinnitus
After treatment, 14 patients no longer complained of otalgia, 5 patients no longer complained of tinnitus, and 2 patients no longer complained of vertigo. [ncbi.nlm.nih.gov]
[…] uncomfortable bite -- as if the upper and lower teeth are not fitting together properly Swelling on the side of your face You may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus [webmd.com]
Skin
- Flushing
However, tissue contamination of the joint may be reduced by flushing saline through the needle into the subcutaneous tissues prior to entering the joint capsule. [ncbi.nlm.nih.gov]
The doctor often injects more solution into the joint to further clean or flush it out. Medication--sterioid or aneshetics--are sometimes injected into the joint. This procedure is sometimes called joint flushing or disc floating. [craniorehab.com]
Sterile fluid is flushed through two ports in the joint to eliminate stagnant fluid and gently stretch the joint. The process reverses negative pressure that interfer with joint disk mobility as well as chemicals that cause pain and inflammation. [inlandempireomfs.com]
Sometimes used for a procedure in which an affected joint is flushed with a corticosteroid. [G. arthron, joint + G. kentēsis, puncture] [medical-dictionary.thefreedictionary.com]
The corticosteroid administered typically only affects the targeted area, but in rare cases may have a systemic effect, causing flushing, insomnia, or, in patients with mood disorders, instability. [orthomedctr.com]
- Skin Atrophy
The frequency of minor adverse events following arthrocentesis has not been previously reported because the focus of most prior reports has been adverse events from glucocorticoid injection (systemic effects, skin atrophy or depigmentation, tendon damage [jrheum.org]
Skin atrophy can sometimes occur if corticosteroids are injected close to the undersurface of the skin. Tendon rupture : Injection of corticosteroids directly into a tendon or tendon insertion can cause rupture. [hss.edu]
Musculoskeletal
- Knee Effusion
Procedure Ultrasound Identification of Knee Effusion We recommend using the linear transducer (10–5 MHz) for both the identification of the effusion and needle guidance for the arthrocentesis. [acepnow.com]
Practice diagnosing and managing the presence of knee effusion with this anatomically correct arthrocentesis model. [simulab.com]
If there was more than a depth of 2 mm of knee effusion, then a second knee arthrocentesis was performed using ultrasound guidance. The aspirated joint fluid volume (in milliliters) (V(2)) was recorded for each knee. [ncbi.nlm.nih.gov]
- Hip Pain
Ultrasound is a useful tool to evaluate and initiate diagnostic and therapeutic measures for patients presenting with hip pain suspicious for effusion. [mdedge.com]
CASE REPORT: An 18-year-old pregnant woman presented with right hip pain, a normal temperature, and elevated inflammatory markers. She had no risk factors for septic arthritis. [ncbi.nlm.nih.gov]
72; hip pain: 39; knee pain: 37), physical examination (limited internal rotation: 98), sonography of capsule neck distance (mean 5.9 mm), duration of hospitalization and morbidity. [synapse.koreamed.org]
The assessment of athletic hip injury. Clin Sports Med. 2001;20:647–59. 3. Adkins SB 3d, Figler RA. Hip pain in athletes. Am Fam Physician. 2000;61:2109–18. 4. Kalb RL. Evaluation and treatment of hip pain. Hosp Pract. 1998;33:131–2.135–6. 5. [aafp.org]
- Osteoporosis
Injected directly into the knee, Supartz targets the osteoporosis in your knee only – and not other parts of the body – and is administered in a series of weekly shots. For more information, visit the Supartz website. [rheumatologydocsli.com]
Additional Contributors James D Fischkoff, MD Arthritis and Osteoporosis Associates Disclosure: Nothing to disclose. [emedicine.medscape.com]
A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting ( 2016 ) Semin Arthritis [biorxiv.org]
Face, Head & Neck
- Facial Pain
Internationally renowned editors and contributor teamIntegrated approach to the diagnosis and treatment of oral and facial pain syndromes as well as common primary headaches A thorough review of the four majorclinical entities of orofacial pain: acute [books.google.de]
[…] protrusion Alterations of occlusion Joint noises associated with pain Contraindications Presence of concomitant facial pain of separate etiologies Chronic pain disorders Presence of deformity or pathology of the TMJ Presence of local or systemic conditions [pocketdentistry.com]
J Oral Facial Pain Headache. 2014;28(1):6–27. Cömert Kiliç S, Güngörmüş M. [dmp.umed.wroc.pl]
Pain medication or anesthesia is injected into tender facial muscles called "trigger points" to give relief. Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain. Low-level laser therapy. [webmd.com]
Neurologic
- Dizziness
A tired feeling in your face Trouble chewing or a sudden uncomfortable bite -- as if the upper and lower teeth are not fitting together properly Swelling on the side of your face You may also have toothaches, headaches, neck aches, dizziness, earaches [webmd.com]
Workup
Abstract Arthrocentesis is a procedure in the diagnostic workup and treatment of joint pain that has few complications. Analysis of joint fluid yields important treatment data. [ncbi.nlm.nih.gov]
Septic arthritis workup. Medscape Reference. Available online at http://emedicine.medscape.com/article/236299-workup#c8. Accessed 9/9/2016. Sofronescu, A. (Updated 2016 April 13). Joint fluid interpretation. Medscape Reference. [labtestsonline.it]
Treatment
MRI was performed before treatment and 6 months after treatment in both groups. [jdrntruhs.org]
One group received arthrocentesis as initial treatment (n = 40), the other group received conventional treatment including soft diet, physical treatment and occlusal splint therapy (n = 40). Follow-up was after 3, 12 and 26 weeks post treatment. [ncbi.nlm.nih.gov]
Prognosis
Abstract We aimed to assess the relationship between myeloperoxidase (MPO) and internal derangement (ID) of temporomandibular joint (TMJ) and effects of arthrocentesis procedure, either alone or in combination with hyaluronic acid (HA) injection on the prognosis [ncbi.nlm.nih.gov]
Success Rate and Prognosis Several studies have found that arthrocentesis is capable of recovering normal mouth opening and reducing pain and functional disorder. [amsjournal.com]
Intra-articular corticosteroid injection has an unpredictable prognosis and can also lead to local side-effects on the joint. Methods A total of 20 patients (11 females and 9 males) aged 17-39 years were enrolled in this study. [parjournal.net]
Influencing factor on the prognosis of arthrocentesis. J Korean Assoc Oral Maxillofac Surg. 2014; 40:155–159. pmid:25247144 View Article PubMed/NCBI Google Scholar 33. Ness GM: Temporomandibular joint arthrocentesis for acute or chronic closed lock. [journals.plos.org]
Etiology
In the second case, the patient was determined to have a noninfectious etiology and also did well. Skilled ultrasound guidance allows hip arthrocentesis to be performed by the treating clinician, decreasing the time to diagnosis and definitive care. [ncbi.nlm.nih.gov]
Arthrocentesis (synovial fluid aspiration) of the knee can be performed either diagnostically (for identification of the etiology of acute arthritis) or therapeutically (for pain relief, drainage of effusion, or injection of medications). [1, 2] To avoid [emedicine.medscape.com]
Figure-1:Trend of total and rate of discharges with arthrocentesis -2004-2013 Fig-2:Trend of proportion of arthrocentesis by arthritic etiology Fig-3:Trend of LOS and mortality among discharges with arthrocentesis Disclosure: D. Poudel, None; R. [acrabstracts.org]
Clinical Significance Arthrocentesis is performed for identification of the etiology or pain relief, injection of medications, or effusion drainage. To avoid complications, the clinician should be familiar with the anatomy. [statpearls.com]
[…] such as closed lock, joint hypomobility, and limited range of motion in maximal incisal opening, excursion, and/or protrusion Alterations of occlusion Joint noises associated with pain Contraindications Presence of concomitant facial pain of separate etiologies [pocketdentistry.com]
Epidemiology
[…] national de la santé et de la recherche médicale (INSERM), UMR 1132, Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, Paris, France; Epidemiology [ncbi.nlm.nih.gov]
Epidemiology of soft-tissue/musculoskeletal injury among U.S. Marine recruits undergoing basic training. Mil Med. 1992;157:491–3. 20. Barber FA, Sutker AN. Iliotibial band syndrome. Sports Med. 1992;14:144–8. 21. [aafp.org]
A retrospective observational study was conducted based on the Helsinki Declaration and recommendations of the report entitled Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) [16]. [journals.plos.org]
Epidemiologic data on the incidence of CA-MRSA septic arthritis are sparse; however, one recent study noted that 50% of synovial fluid cultures in suspected septic arthritis ultimately grew MRSA.12 It would be prudent to consider empirical therapy for [veteriankey.com]
Epidemiologic data on the incidence of CA-MRSA septic arthritis are sparse; however, one recent study noted that 50% of synovial fluid cultures in suspected septic arthritis ultimately grew MRSA. 12 It would be prudent to consider empirical therapy for [aneskey.com]
Pathophysiology
However, thoroughly testing of these treatment modalities in the TMJ itself remains needed, because differences in pathophysiology between the TMJ and other joints may influence the clinical results. [rug.nl]
Pathophysiology of TMJD could be described by several theories: (i) Changes in the shape and position of the articular disk, (ii) biomechanical and biochemical changes in TMJ, (iii) joint overloading may cause hypoxia and on termination of overloading [jdrntruhs.org]
Current concepts review: septic arthritis of the knee pathophysiology, diagnostics, and therapy. Wien Klin Wochenschr 2011;123:191–197. Stutz G, Kuster MS, Kleinstück F, Gächter A. [jkoa.org]
Explain the pathophysiology and6. Explain the pathophysiology and treatment for gouttreatment for gout 7. Emergency Medicine ObjectivesObjectivesObjectivesObjectives 7. Differentiate “rheumatic fever”7. [slideshare.net]
Complex regional pain syndrome: epidemiology, pathophysiology, clinical manifestations, diagnostic tests and therapeutic proposals. Rev Bras Anestesiol. 2002;52(5):618-27. [ Links ] 44. Al-Belasy FA, Dolwick MF. [scielo.br]
Prevention
Aspiration in cases of hemarthrosis can prevent adhesions. Aspiration can be performed immediately prior to injecting intra-articular medications. [boneandspine.com]
In order to minimize the effects of this process on the quality of life or even preventing it from becoming chronic, adequate intervention is essential. [rug.nl]
[…] to use only arthrocentesis in patients without preoperative degenerative changes and arthrocentesis with SH in patients with degenerative changes on their preoperative MRIs, but because there were some significant differences between the two groups preventing [ncbi.nlm.nih.gov]
While treatment of IMPA is based on chronic immuneosuppressants to help prevent that body from continuing to attack the joints. [vcahospitals.com]
It can also help prevent the fluid from building up again. [signaturemedicalgroup.com]