1Technique of puncture of the knee joint
- 1.1The structure of the knee joint
- 1.2Knee articulation points
- 1.3Technique of puncture
- 1.4The technique of standard puncturing
- 1.5Puncture of the upper curtain
- 1.6Puncture of the bottom twists
- 1.8In what cases is the puncture contraindicated?
- 1.9Complications of manipulation
2Puncture of knee joint: indications, technique of performance
- 2.1Indication for diagnostic puncture
- 2.2Indications for therapeutic puncture
- 2.3Contraindications not for all patients
- 2.4Technique of execution
- 2.5Complications after the procedure
3Puncture of knee joint: indications, technique of performance
- 3.1What is the puncture of the knee joint?
- 3.2Types of punctures
- 3.3Therapeutic puncture
- 3.4Diagnostic puncture
- 3.5Points of punctuation
- 3.6Indications for prescription
- 3.7Contraindications to prescription
- 3.8How is the puncture performed?
- 3.9The technique of standard puncturing
- 3.10Puncture of the upper curtain
- 3.11Puncture of the bottom twists
- 3.12Complications and side effects
4Puncture of the knee joint: the technique of performing, for what, how do they do it?
- 4.1Puncture of the joint - what is it?
- 4.2Indications for taking a puncture of the knee joint
- 4.3Puncture of the joint as a diagnostic method
- 4.4Technique of puncture of the knee joint anesthesia
- 4.5Synovial fluid analysis
- 4.7Possible complications after the procedure
- 4.8Contraindications to the procedure
5Puncture of knee joint: indications, stages of procedure, possible consequences and responses
- 5.1What is joint puncture?
- 5.2Indications for referral to the procedure
- 5.3Causes and Symptoms of Synovitis
- 5.4Stages of joint puncture
- 5.5Possible consequences of treatment
Technique of puncture of the knee joint
Joint puncture is a valuable diagnostic and therapeutic method, widely used in traumatology and rheumatology.
This is a surgical manipulation, in which the needle is inserted into the joint cavity for the collection or pumping of fluid, the introduction of drugs.
The knee joint is punctured with inflammatory and degenerative diseases, with accumulation of fluid in it, with tuberculous and tumor process, reactive arthritis, rheumatological diseases.
Depending on the cause and medical necessity, the following types of punctures are distinguished:
- Evacuation. In this case, the joint is released from the accumulated pathological fluid.
- Diagnostic. A small amount of liquid is extracted from the articular cavity for examination.
- Therapeutic. The junction is punctured to bring the medicine inside. Used for ineffectiveness of conventional treatment and severe forms of the disease. For intraarticular administration, anti-inflammatory hormonal drugs, corticosteroids, are usually used.
Puncture of the knee joint requires a good knowledge of the anatomy of this area of the human body.
The structure of the knee joint
The lower part of the femur is in contact with the upper part of the tibia with the help of the protrusions - the condyles.
In order for the articular surfaces to correspond to each other, between them are dense cartilaginous interlayers - menisci. In front, the knee joint is limited to the patella, the most mobile part of it.
The ability of the patella to move in different directions is widely used when puncturing.
Inside the cavity is lined with a so-called synovial membrane, which forms folds and numerous twists.
Knee articulation points
Depending on the purpose of puncturing, the presence or absence of a large amount of intra-articular fluid, this manipulation can be carried out using different approaches.
The following options are used, or punctuation points:
- Standard access. In this case, the needle is inserted from the inner or outer side of the upper pole of the patella.
- Access to the upper backbone of the knee joint. It is carried out through a puncture from the outer or inner side of the head of the quadriceps femoris muscle.
- Access to the bottom curls is carried out through the most protruding part of them from the outer or inner side - depending on the accumulation of liquid.
Technique of puncture
There are standard requirements for the technique of performing a puncture of the knee joint.
Since this is a surgical operation, it is mandatory to treat the skin with an antiseptic agent (alcohol solution of iodine, then ethyl alcohol). The procedure is performed under local anesthesia.
When carrying out the manipulation, the patient lies on his back with a roller under his knees.
The technique of standard puncturing
With a standard puncture, a gap is defined between the condyle of the thigh and the posterior surface of the patella.
Through it a standard needle 4-5 cm in length is inserted into the joint cavity. A stop signal for the surgeon is a feeling of failure in the void, a sharp cessation of tissue resistance.
This indicates that the needle is in the joint cavity.
Sometimes the needle can rest against the bone. In this case, it is necessary to disconnect it from the syringe and, after a little pulling, move until it is in the joint cavity.
Puncture of the upper curtain
The puncturing of the upper curvature is carried out if a lot of fluid has accumulated in the knee joint. It is then that the vortex becomes clearly visible.
When you press the lower arm on the knee, the pathological fluid moves to its upper part, where the puncture is performed through the quadriceps muscle of the thigh.
Puncture of the bottom twists
In this situation, on the contrary, liquid is pushed downwards by pressing a hand on the upper part of the joint. The most protruding part of the curvature is determined, and the needle is inserted in the direction from top to bottom and into the interior of the articular cavity.
When carrying out manipulation for anesthesia, infiltration anesthesia is used. This means that the anesthetic penetrates - infiltrates - all the tissues along the path to the joint.
At first, the skin becomes numb because it has the highest sensitivity. For this, a thin needle is inserted into it at an angle and the drug is slowly injected. With the correct injection, the skin in this place becomes like a lemon crust.
Further, the needle is guided towards the capsule of the joint, continuing to continuously inject the solution into the tissue.
Having reached the articulation, the needle is changed to a thicker one - puncture, if you need to take a little liquid for research or evacuate a large amount.
In the event that the puncture is curative, only the syringe with the medicine changes, the needle remains the same.
For infiltration anesthesia, the following is usually used:
- Novocaine solution, 1 or 2%;
- lidocaine solution, 1%.
The medicine for anesthesia is selected, taking into account individual tolerability in order to avoid life-threatening allergic reactions.
In what cases is the puncture contraindicated?
Contraindications to the puncture are:
- Already known allergic reaction to anesthetic or injected drug substance.
- Diseases of the skin and soft tissues in the area of supposed manipulation.
- Diseases of the blood coagulation system. Especially it concerns such a dangerous disease as hemophilia - because of the risk of bleeding.
Relative contraindications include endocrine diseases - for example, diabetes mellitus, especially in the case of intra-articular hormonal substances.
Complications of manipulation
In rare cases, the puncture of the knee joint may be complicated by attachment of the infection. This occurs when non-compliance with the rules of asepsis and manifests itself in the development of purulent arthritis.
If the blood clotting is impaired, the patient's puncture threatens him with serious bleeding.
A source: http://MedOtvet.com/diagnostika-sustavov/tehnika-punkcii-kolennogo-sustava.html
Puncture of knee joint: indications, technique of performance
In some cases, with diseases of the knee joint, the doctor has to prescribe to his patient, for diagnostic or therapeutic purposes, a procedure such as puncture.
For its implementation, a puncture of the skin and the introduction of a needle into the joint cavity are carried out.
In the future, through the needle, the doctor can remove fluid or blood from the joint or inject necessary medications into it.
Many patients who first encounter such a procedure are afraid of conducting it, and they have many questions about the need and the technique of its implementation. In this article, we will acquaint you with indications, contraindications, possible complications and technique of puncture of the knee joint.
Puncture of the knee joint can be prescribed both for diagnostic purposes and for therapeutic purposes.
Indication for diagnostic puncture
In some cases, all types of patient tests used do not allow the doctor to accurately establish a diagnosis without performing a joint puncture.
Only with this procedure the doctor can draw fluid from the joint cavity for analysis, prepare the joint for X-ray or pneumography and detect the presence of pathological inclusions.
Diagnostic puncture of the knee joint can be prescribed in such cases:
- The need to determine the nature of the contents in the joint cavity (blood, pus, exudate). The presence of blood in the joint cavity can lead to the development of inflammation (synovitis), degenerative-dystrophic lesions of cartilaginous tissue and the formation of intraarticular adhesions leading to stiffness or obliteration the joint. A congestion of exudate and pus significantly hamper the treatment and lead to the development of complications. Analysis of the fluid obtained during the puncture of the knee joint allows accurate diagnosis, reveals the type of pathogen of purulent complications and prescribes adequate treatment.
- Suspicion of the presence in the joint of "rice bodies" or "joint mice". Such intraarticular bodies are formed due to some articular processes, accompanied by loss and clumping of fibrin, or during traumas (dislocations, fractures, etc.). Their presence in the joint cavity leads to the appearance of pain and disruption of its functions, since such formations can get between the articular surfaces.
- The need for X-ray or pneumography to detect meniscus lesions. To carry out such diagnostic tests in the cavity of the knee joint, 80-90 cm3 oxygen (for pneumography) or 5-10 ml contrast drug Urotrast with a solution of novocaine (for radiography).
Indications for therapeutic puncture
Puncture of the knee joint can be performed for diagnostic or therapeutic purposes.
In some diseases, effective treatment of the knee joint can be achieved only with the help of its puncture.
Used ointments and tablets can not have such a curative effect as solutions injected directly into the joint cavity.
A congestion of fluid, pus or blood can be removed only with a needle and a syringe.
Medical knee joint puncture can be prescribed in such cases:
- removal from the articular cavity of blood after trauma or accumulation of exudate and pus, interfering with recovery of the patient;
- the introduction of corticosteroids (in combination with Lidaza) with deforming arthrosis;
- injections of solutions of antibiotics for purulent-inflammatory processes;
- intra-articular injection of drugs for the restoration of cartilaginous tissue with deforming arthrosis;
- the introduction of local anesthetics for anesthetizing the procedure of joint repositioning;
- removal of synovial fluid from Baker's cyst;
- the need to introduce oxygen or air for a more careful destruction of adhesions caused by fibrous fissures.
Contraindications not for all patients
Puncture of the knee joint may not be prescribed to all patients, but only in the absence of contraindications to its implementation:
- presence on the skin of rashes, wounds or other injuries;
- endocrine pathologies (puncture is performed only in the absence of the possibility of eliminating inflammation in other ways);
- disorders of blood clotting (puncture can be performed only after special preparation of the patient with the help of medicines).
Technique of execution
The synovium is extremely sensitive to infectious agents and therefore the procedure for puncturing the knee joint should be performed in compliance with all rules of asepsis and antiseptic in the conditions of specialized cabinets. It is performed after the onset of local anesthesia in the prone position.
The procedure for puncturing the knee joint is performed in the following sequence:
- The patient is placed on his back, and under the knee a roll is placed, which allows to relax the muscles of the leg.
- The knee skin is disinfected with a 5% solution of iodine, and its traces are removed by double flushing with 70-degree alcohol. This technique is used to prevent the penetration of iodine particles at the tip of the needle into the joint cavity.
- With the introduction of lidocaine or novocaine, local anesthesia is performed.
- To make a puncture, select the necessary needle. Its diameter for removing blood or pus should be up to 2 mm, and for administration of medicinal solutions or oxygen - not more than 1 mm.
- Place for puncture is determined by the doctor individually. As a rule, it is performed slightly to the side of the patella. With a Becker cyst, the tumor is pricked.
- Before the puncture, the doctor slightly shifts the skin to the side. This manipulation is performed to curl the canal made by the needle. After removing the needle, the skin will return to its place and prevent penetration of infectious agents into the joint cavity.
- When the puncture is performed, the doctor slowly moves the needle and, on the appearance of a sensation of a dip indicating the penetration of the needle into the joint cavity, stops its progression. Depth of puncture can be from 1 to 2-3 cm.
- After the puncture, the administration of drug solutions, the collection of blood or fluid, the introduction of oxygen or contrast medium. A syringe of 20 ml is used for suctioning the liquid.
- After the diagnostic or treatment procedures are completed, the doctor removes the needle, treats the puncture site with alcohol and applies a sterile napkin that is fixed with a tight bandage.
- After the removal of blood, a pressure bandage is recommended.
Complications after the procedure
Professional performance of puncture of the knee joint rarely leads to complications.
Sometimes the patient may have allergic reactions to the introduction of certain medications.
They manifest themselves in the form of contact dermatitis or skin rashes and are usually easily eliminated with antihistamines.
In more rare cases, puncture of the knee joint can be complicated by the following consequences:
- change in skin color in the puncture area;
- the appearance of a hematoma in the puncture zone;
- infection of the joint;
- damage to cartilaginous tissue;
- rupture of the synovium.
According to most experts, the risk of complications increases with each repeated puncture.
Puncture of the knee joint can be prescribed for both diagnosis and treatment.
In some cases, this procedure is the most effective curative measure.
To prevent possible complications, it should be done only by an experienced doctor and with all the rules of aseptic and antiseptic.
A source: https://myfamilydoctor.ru/punkciya-kolennogo-sustava-pokazaniya-texnika-vypolneniya/
Puncture of knee joint: indications, technique of performance
Actively affect the course of the pathological process of the musculoskeletal system is assisted by puncture of the knee joint. According to the indications, puncture of the hip joint, as well as other affected joints, is performed.
What is the puncture of the knee joint?
The therapeutic measure is performed by inserting a special needle into the cavity through special points.
For this, it is necessary to pierce the skin, muscle layer, tendons and articular membrane.
This procedure can be performed only by a qualified traumatologist in a specially equipped office or hospital.
Types of punctures
Depending on the purpose, therapeutic and diagnostic manipulation is distinguished.
The introduction of the drug into the joint cavity is the most effective way of influencing the inflammatory and degenerative processes of the musculoskeletal system.
The advantage of the method is to minimize the side effects of the drugs, as well as their direct influence on the tissues.
To achieve the desired effect using the same technique, the ankle joint and other damaged joints are punctured.
With a curative purpose, a joint cavity is administered:
- anti-inflammatory steroid and non-steroid agents;
- saline solution for washing;
Treatment with direct administration of drugs in the joint area allows you to most effectively influence the pathological process.
Dot the joint in order to extract from it:
- excess synovial fluid;
- purulent contents.
Removal of a pathological exudate with the help of a puncture contributes to the rapid recovery of the patient.
To clarify the nature of the inflammatory process, as well as to recognize traumatic joint damage, a puncture will help.
The intake of fluid allows us to determine the causative agent that caused the infectious process.
The receipt of contrast preparations makes it possible to diagnose traumatic lesions of the meniscus and articular surfaces.
Points of punctuation
Correctly selected points for puncture of the knee joint will ensure painless penetration into the cavity, without damaging important formations. A reference point in this is the patella.
Puncture follows the place from the outer or inner side under the bottom edge or below the midline by approximately 5 mm. It is permissible to perform a puncture 1 cm above the upper edge of the patella.
The needle is located parallel to its internal surface.
Indications for prescription
The puncture of the affected knee is necessary in the following situations:
- accumulation of blood in the joint cavity (only its mechanical removal can restore functioning);
- damage to the synovium due to traumatic effects and excessive accumulation of intra-articular fluid;
- if there is infection of the joint bag with the formation of purulent contents;
- anesthesia with the introduction of local anesthetics, manipulation of the direction of dislocation of the knee joint;
- deforming processes with degeneration of the cartilaginous surface and the presence of pain in the affected area;
- Baker's cyst (its contents are deleted);
- progressive adhesion process.
Complex traumatic injuries require the introduction of contrast agents by puncturing for accurate diagnosis of the pathological process.
Similar indications are puncture of the elbow joint and other articulations.
Contraindications to prescription
The procedure can not be performed if the patient has:
- violation of the integrity of the skin in the projection of planned manipulation;
- psoriatic formations and rashes of other origin in the knee joint;
- general intoxication with a febrile condition.
How is the puncture performed?
The technique of performing a joint puncture (knee) involves the following steps:
- Giving the patient a comfortable position (lying on his back, a soft cushion is located under the knee or ankle to relax the muscles of the leg).
- Disinfection of the skin of the knee joint with 5% alcohol solution of iodine, and then with 70% solution of ethyl alcohol.
- Selection of necessary needles: their diameter for the introduction of drugs and oxygen should be 1 mm, and for pumping out the liquid - no more than 2 mm.
- Depending on the purpose of the puncture, prepare a syringe with a volume of 5 to 20 ml.
To prevent the patient from being hurt during the procedure, local anesthesia is performed, for which the skin in the bypass zone is cured with Novocain or Lidocaine.
The skin fold at the puncture site is shifted to make the puncture needle channel curvature. This prevents the possible entry of an infectious agent into the joint cavity.
After the end of the procedure, the injection site is closed with a pressure bandage.
In the same sequence, the shoulder joint and other affected joints are punctured.
The technique of standard puncturing
Puncturing by traditional technology involves inserting a needle into the slotted hole, which is determined palpably.
It is located between the large trochanter of the femur and the zone of the posterior edge of the patella.
Upon entering the cavity, a feeling of falling into the void appears, this signals the correct conduct of the manipulation.
If the needle hits the bone surface, you will need to move until a feeling of failure occurs.
Puncture of the upper curtain
The formation of a large amount of synovial fluid makes it possible to puncture the joint using the technology of the upper curvature.
The palm is pressed down on the lower part of the patella and displaced upward. The pathological effusion also shifts upward.
The needle is guided into the articular cavity through the quadriceps of the thigh.
Puncture of the bottom twists
The technology of puncturing by this technique involves the introduction of a needle in the region of the lower part of the patella in the direction of the joint cavity. The knee is displaced by pressing the hand from the top down.
Complications and side effects
Adverse effects of puncture of the knee joint are only in case of a violation of technology: properly performed manipulation is not accompanied by pronounced painful sensations. Ignoring the rules of asepsis and antiseptics can cause infection of the joint tissues.
When the reaction of intolerance to an anesthetic or therapeutic agent develops, there is a rash in the form of urticaria. The most common cause of allergic reactions are the following drugs:
- Novocain or Lidocaine;
- nonsteroidal anti-inflammatory drugs.
With care perform manipulation of joint puncture, if the patient is diagnosed with diabetes, because of the possibility of formation of a non-healing trophic ulcer at the site of puncture.
There is a possibility of mechanical damage to the synovial membrane until its complete rupture. Complication does not occur with strict performance of the technique of joint puncture.
Puncture of the knee joint is one of the most effective medical and diagnostic procedures for pathological conditions and trauma.
Compliance with the punctuation technology and its timely implementation provides a quick positive effect.
Intervention should only be performed by a qualified specialist in the surgical department.
A source: http://NogiNashi.ru/sustavy-i-kosti/vidy-i-texnika-provedeniya-punkcii-sustava.html
Puncture of the knee joint: the technique of performing, for what, how do they do it?
Problems with the musculoskeletal system require comprehensive medical intervention. Only specialists can choose the optimal therapeutic tactics for the purpose of restoring the motor functions of the lower extremities.
Today it is widely practiced: arthroscopy, prosthetics and puncture of the knee joint as a method of treatment for pain and osteoporosis and in combination with honey. drugs, physiotherapy, magnetotherapy gives quite positive results.
How is the puncture performed, with what purpose, to whom is it prescribed and to whom is contraindicated we consider in more detail in this article.
Puncture of the joint - what is it?
PunctureIs a small puncture with a medical needle into the articular cavity (to the affected area) in order to diagnose or prescribe further therapeutic procedures for the physician in the future.
Only a specialist will be able to take a puncture according to all the rules, tk. method requires a fairly accurate holding, with knowledge of all the main points of acupuncture, in particular the structure of the knee joint.
Lack of knowledge can only exacerbate the patient's situation, lead to an increase in unpleasant painful symptoms, complications and limitation of mobility of the knee with accidental damage to the nerve endings.
Manipulation is used exclusively by a surgeon or traumatologist and only in a hospital setting with the necessary honey. tools
Indications for taking a puncture of the knee joint
The frequent cause of pain in the knee is the development of contracture. Patients begin to complain of constant pain, limited mobility and of course, you need to take action.
Puncture is the same with the purpose:
- the purpose of the treatment course;
- conducting diagnostics;
- in postreabilitatsionny period, i.e. at the time of restoration of the joint.
The method is shown to be conducted when:
- rheumatism of the feet;
- inflammatory and degenerative processes or accumulation of purulent exudate in the knee;
- the need to obtain an analysis of the joint by injecting a contrast fluid;
- clarification of the diagnosis, if severe pains are concerned, but the nature and provoking factors are not revealed.
Puncture is often performed for medicinal purposes, when doctors at the expense of a puncture can deliver the injected medicines (glucocorticoids, anesthetics, hondoprotectors) in the cartilage tissue or directly into the self joint.
Attention! Like any other method, puncture can be unsafe. It happens that it leads to allergies, rashes on the skin due to a number of medications being administered.
Also, with poor blood coagulation, the method must be performed with extreme caution
The main points in the knee joint for taking a puncture are:
- just above the kneecap;
- from the inner or outer side of the quadriceps femoris muscle;
- on the protuberance of the stone in places of fluid accumulation.
The method by introducing oxygen into one or another point is effective for therapeutic purposes with pathology in the meniscus, congestion inflammatory exudate, degenerative changes in the background of coxarthrosis, gonarthrosis, traumatic hemarthrosis in the knee.
Puncture of the joint as a diagnostic method
The procedure is prescribed for severe trauma or damage to the knee, accumulation of exudate (effusion) inside the joint, as well as for analysis (study) of the fluid during the diagnosis.
With degenerative changes in the joint cavity, the fluid that has accumulated is subject to investigation.
In the laboratory, its consistency, color, odor, and the presence of an admixture of blood (pus) are studied.
At one of the points of the knee, a contrast agent or air with nitrogen supply is introduced.
This is a kind of X-ray examination or pneumoarthrography to clarify the nature of the disease, the degree of damage to the ligaments or meniscus, the study of foreign tumors.
Puncture as a diagnostic methodfor doctors it is considered difficult and it is not always possible to pump out the entire accumulated liquid in the joint bag from the first time. Nevertheless, this is one of the main methods for doctors when prescribing treatment.
For example, with the synovitis of the knee, local medicines, ointments, creams for rubbing help. With the development of inflammation and the accumulation of pus in the bursa of the joint, what happens with bursitis, you can not do without the appointment of antibiotics, pain medications.
They are also injected with a needle with a syringe in the syringe to relieve the inflammation, reduce the pain and thereby ease the patient's condition.
If it is necessary to pump the accumulated liquid into the joint cavity, then oxygen is introduced both for therapeutic purposes and for restoring the mobility of the knee during the rehabilitation period.
Important! Untimely performed puncture can lead to deterioration of the patient's well-being and slower resorption, for example, hematoma in case of a stroke or a fall in height.
Although the technique should only be carried out by a specialist
With the evacuation of synovial fluid in domestic home-grown conditions, new problems can be acquired, including infection of the knee and the development of sepsis.
Technique of puncture of the knee joint anesthesia
The technique is simple. The patient will be asked to sit on a chair and take a comfortable position, bending his leg in the knee at an angle of 15 g and placing a small hard roller under his leg.
The doctor will perform a number of standard manipulations:
- wrapping a sick knee with a towel;
- fence into the syringe of the necessary honey. substances (antiseptics, chlorhexidine 0 5%);
- Studying of sick points, conducting acupuncture and marking on the knee with a felt-tip pen;
- wiping the puncture site and the tip of the needle with alcohol, iodine;
- Insertion of the needle from the outer (inner) side of the upper pole or under the upper turn of the patella, apex or head of the quadriceps muscle, protrusion from the outside of the femur or to the site of the serosa liquid;
- a slow but continuous introduction of the solution into the joint until the needle touches the joints;
- the imposition of a sterile dressing or gypsum, fixation.
If necessary, the doctor can change the needle to a thicker one when pumping out a large amount, also for medicinal purposes, replace the medicine, i.e. enter once at once 2-3 different med.preparata.
It is possible to conduct infiltration anesthesia with lidocaine or novocaine.
This means for anesthesia, although the doctor on the eve of taking a puncture should find out from the patient whether an allergic reaction will occur after the administration of that other drug.
Then you can apply ice or bandages moistened with cold water every 20-25 minutes to anesthetize and somehow fix the result.
Synovial fluid analysis
Synovial fluidin the joint plays an important role and is a kind of barrier for the onset of viruses, bacteria, preventing their reproduction during ingestion, for example, through wounds and cuts on the skin.
The fluid constantly bathes the joint, but it reacts sensitively to the development of pathology or the inflammatory process. Under such pressure, the joint begins to change, and the pathological purulent fluid accumulates.
The puncture also allows the accumulation of accumulated effusion or purulent exudate in the part of the knee, as well as the extraction of synovial fluid is necessary for physicians to study under a microscopefor evaluation purposes:
- volume of clots;
- degree of turbidity;
- the number of leukocytes.
Normally, the synovial fluid -light yellow color. But when a greenish shade appears, it can be suspected of developing rheumatism, gout, arthritis. If the structure of the liquid is loose, it is most likely that an inflammatory process develops in the joint.
Experts conduct a count of leukocyte cells in synovial fluid, the indices of which are extremely are important for the purpose of prescribing further treatment, especially in dystrophic processes in the knee the joint.
In normal cells should not be more than 200/1 μl, but with:
- gout increased the content of calcium dihydrogen phosphate crystals;
- Rheumatoid arthritis is the content of C-reactive protein and the inflammatory process is likely to develop.
Precisely the results of puncture are necessary to clarify the diagnosis or the purpose of treatment. Also, the method is effective after knee surgery to accelerate the healing processes in the joint or at least significantly improve its functional qualities.
Puncture will help relieve pain and swelling, stop the development of inflammation.
After conducting and studying the composition of the synovial fluid, the doctor will give an opinion, i.e. an interpretation of the results of the analysis was made and an accurate diagnosis was established.
This helps prevent possible complications, minimize unpleasant symptoms in the knee. Typically, patients after taking the puncture experience significant relief and pain passes.
Possible complications after the procedure
In spite of the fact that the puncture for doctors is extremely important for medical purposes, patients are often very difficult to bear.
Rarely, but from the complications there is the appearance of an allergic reaction to the skin from the administration of medications or admission of errors by an inexperienced doctor when manipulations are performed incorrectly.
What can happen? It:
- development of purulent arthritis or sepsis right up to blood poisoning;
- rupture of the synovium;
- impaired blood clotting;
- heavy bleeding;
- the appearance of an allergic rash.
Puncture or puncture should be performed only by a specialist and in - sterile hospital conditions
Contraindications to the procedure
Knee puncture in treatment is assigned to virtually all patients in a row, since a safe method of diagnosis does not lead to serious side effects.
The method is not carried out when:
- allergic reactions;
- individual intolerance of medications administered;
- cardiovascular diseases;
- presence of open wounds, cuts in the knee area.
You can not conduct a method to beginners, without the necessary knowledge and experience in this case. Only an experienced doctor first visually inspect the affected area and identify the extent of possible punctuation.
Many patients ask: is it painful to conduct such a procedure? If conducted by an experienced specialist, then there will be no special pain
The place for a puncture is carefully examined, the zone that is subject to the inflammatory process or degenerative changes is taken into account.
The complication is the accumulation of purulent fluid in the bursa due to their complex anatomical structure. Perhaps the injection of the solution from the syringe into one or two alternately articular bags.
When properly manipulated by an experienced physicianpuncture brings considerable relief to the patients, accelerates the recovery process after performing the operation on the joint, regenerates and nourishes the internal subcutaneous layers.
Doctors do not recommendto refuse a puncture of the knee joint, if it is appropriate. The method helps restore the motor ability of the joint and is widely used today by surgeons, orthopedists, traumatologists.
In a complex and in combination with other medicinal preparations it gives excellent results for restoring the knee joint, eliminating unpleasant symptoms of soreness.
A source: http://prosustavi.com/diagnostika/punkciya-kolennogo-sustava.html
Puncture of knee joint: indications, stages of procedure, possible consequences and responses
In the treatment of diseases of the musculoskeletal system in current medicine, an integrated approach is applied.
Combinations of drugs of different groups are well combined with surgical interventions, mechanotherapy and physiotherapy, folk remedies.
Prosthetics, arthroscopy, and puncture nowadays are widely used for the resumption of movement functions.
What is joint puncture?
Puncture of any jointIs the name of the procedure according to which the intra-articular lancing is pierced through the skin with a needle with penetration into the cavity. The puncture is performed for therapeutic or diagnostic purposes.
The technique of puncture (it is also called arthroposal or puncture) requires the professional to be professional and accurate so as not to damage the nerve endings. Otherwise, it can cause a sharp pain and, worse, a significant restriction in the movements.
For this reason, such a procedure is performed exclusively by a specialist (surgeon and / or traumatologist) in a hospital.
An important role in this treatment is played by the individual anatomical structure of the joints, as well as the location of the surrounding tissues of a single patient.
For example, on the forearm, large vessels and nerves are located rather superficially, for this reason, arteriapuncture of the elbow joint is performed with extreme caution.
The well-developed musculature of the limbs, on the one hand, protects the joints from injuries, on the other hand it interferes with the operative access to them.
For example,puncture of the hip jointimplies a complicated technique of implementation and involves the use of special devices.
Indications for referral to the procedure
This procedure is quite common in surgery and traumatology. With the diagnostic and therapeutic purpose, knee joint puncture to the patient is prescribed in the following cases:
- In case of traumatic injuries of the meniscus, ligaments, serious fractures or bruises - to remove blood from the cavity inside the joints. By the type of exudate (liquid), a professional is able to determine the presence and extent of damage to bone structures, the fact of the presence of an infectious infection.
- In inflammatory and rheumatic diseases, the removed liquid is directed to an immunological or bacteriological study. In most cases this makes it possible to establish the cause of the pathology, confirm (or refute) the diagnosis and prescribe the appropriate therapy.
- With a pronounced pain syndrome that can occur with rheumatoid or deforming arthrosis, systemic joint pathologies, a drug is injected into the intraarticular cavity. The most commonly used glucocorticosteroids (Kenalog, Diprospan, Hydrocortisone), which mainly have anti-inflammatory and anesthetic effect. In recent years, drugs of hyaluronic acid (Duralan, Fermatron, Ostenil) are often used, called a little bit figuratively - "liquid prostheses". They stimulate the restoration of functions and the regeneration of cartilage.
- When preparing for non-invasive diagnostic methods, a contrast preparation is pre-injected before the MRI (magnetic resonance imaging) of the knee joints. This method allows the doctor to diagnose and in the future to treat all kinds of joint diseases.
- When eliminating dislocations, a medication is injected around and inside the damaged joint to relax and anesthetize the muscles. Very often in such cases, a puncture of the shoulder joints is performed.
Important to the patient before the introductionof various drugs to pre-report allergic or other drugs taken in order to avoid drug side effects.
Causes and Symptoms of Synovitis
If the knee joint localizes pain, you should immediately consult a doctor. The fact is that this may be the initial signs of synovitis. This disease can occur at a very different age.
It arises because of allergic reactions, arthritis, trauma.Next to the knee jointbegins in significant quantities to accumulate fluid, thanks to this, any movement of the foot raises acute pain.
There are basic signs on which this disease can be established:
- The knee grows in size.
- There is cyanosis or redness around the joint.
- There are sharp painful sensations.
- In rare cases, an increase in body temperature.
Puncture will cope with the disease. The doctor removes unnecessary liquid, then the antibiotic is injected into the leg.In this case, the patient immediately feels relieved.
The disease is dangerous because if the problem is not rectified in time, the knee joint can completely collapse, while hitting the meniscus.
To cope with this trouble, you will need long-term treatment and surgical intervention.
Stages of joint puncture
The technique of the procedure is identical on each of the joints. Let's talk about carrying out this procedure on the knee joints.
Counting a simple anatomical structure, knee puncture is more simple. The technique of performing knee joint puncturing consists of several stages:
- The leg is bent in the knee at an angle of 10-17 degrees. For the support of the leg and the relaxation of the quadriceps muscle of the thigh, a low roller is usually placed under the knee (rather hard, but not rigid, as a rule, its role is performed tightly rolled up towel).
- Before the start of the procedure, the skin over the joint is carefully treated with a quality antiseptic. To do this, use a 3% solution of iodine, an alcohol solution,% chlorhexidine or 1% solution of degin. After that, the skin should be rubbed with alcohol, since the ingress of iodine at the tip of the needle into the intraarticular space can cause a burn of the synovial membrane. In the current years for disinfection of the field for surgeries, already ready antiseptic solutions that do not cause allergic reactions and irritations (Alsofet Red, Veltosept, Kutasept) are used.
- The arthroposal is performed by means of a syringe for 15-20 ml (for removing the liquid) or for 5-10 ml (with medication) with a needle length of about 4-6 cm and a thickness of -2 mm.
- The skin is pinched at the puncture site - due to this, the puncture stroke is bent. Such a simple method makes it difficult to penetrate the infection and the outflow of the pathological contents of the articular cavity back through the puncture.
- The central points of the puncture of the knee joint are access to the space inside the joints: 1 cm higher patella, directly below the lower end of the patella from the inner or outer side, at, 5 cm below the center patella.
- Penetration of the needle into the recess of the joint will be accompanied by a feeling of "failure" both in the patient and in injecting a needle into the body. The course of the needle movement must correspond to the location of the plane of the joint slot.
- The puncture site is covered with a sterile bandage. In addition, it is mandatory to fix the limb with a light cast plaster, which, in the absence of complications, is replaced by a knee in 3-4 days. In the place of the joint, the first half a day is recommended to apply cold bandages every 3-4 hours for 15-20 minutes, not more - to avoid the occurrence of painful sensations. It must be remembered that every puncture of the joint wall, despite the fact that this is a medical procedure, is a trauma to the joint. If there is a violation of the technique of performing arthrocentesis or the lack of treatment of the outer covers, there is a risk of infection of the joint.
Possible consequences of treatment
If all the rules are met, due to the puncture, there is a positive dynamics in the treatment process.When removed from the jointexcessive exudates and painful sensations are eliminated, since the intra-articular pressure decreases.
With the introduction of medicines in the knee, inflammatory counteractions of the body are removed, soreness and swelling disappear, regeneration processes increase.
Only after a day the patient can be taken for rehabilitation treatment, including physiotherapy and exercise therapy.
Use of inappropriate tools (too large diameter and the size of the puncture needle) can cause damage to ligaments, bone structures or nerves of muscles (puncture of the elbow joint).
Occasionally, local irritation of the skin surface may occur in the area of iodine treatment.
Actually, therefore, it is recommended to use modern antiseptic agents.
Regular administration of hormonal drugscan lead to destruction of intraarticular cartilage.
It is extremely important to carefully follow the instructions for the use of each pharmaceutical preparation. For example, the combination of certain drugs with concomitant hypertension, diabetes, kidney or liver damage can significantly aggravate the patient's condition.
Carrying out a puncture of the knee joint by a professional contributes not only to the resumption of a normal lifestyle, but also to a speedy recovery.
Negative consequences may be accompanied by:
- infections of the joint;
- rupture of the synovial cover.
If the knee is swollen, the temperature rises, there are throbbing or "burning" pains, should immediately seek medical help, because such signs indicate the penetration of infection in the joint.
A similar symptomatology can not be expressed immediately, and a few days after the completion of the procedure. Avoid infection by observing the technique of puncture and all precautions.
Many medications that are intended for insertion into the knee joint are purposefully manufactured in disposable syringes.
If there is a rupture of the shell, the acute pain is felt instantly, as the liquid begins to flow into the soft tissues of the body. Fortunately, such a complication is very rare.
Probable and allergic reactions, but not on the puncture, but on the substances that are part of the drugs prescribed for therapy. That's why the doctors are not guilty in this case.
Not so often, but nevertheless there are situations when from a puncture it will be better to refuse. This decision is made when the patient himself can damage the procedures themselves more than they can bring benefits.Such cases include the following indicators:
- Intensified coagulability of blood.
- On the surface of the skin there are abscesses or wounds.
- The patient has psoriasis.
- The patient was diagnosed with skin cancer.
In other cases, this therapeutic measure can be safely appointed and conducted. The most important thing is to find a competent specialist who will be able to conduct all manipulations correctly.
In various forums you can often see the question:"If the joint hurts in the knee, is it necessary to carry out a puncture or can it be avoided?".
The doctors are sure that it is very difficult to cure the synovitis without this procedure.
To begin with, it is deemed necessary to remove the excess fluid, and after that prescribe the use of ointments and the intake of antibiotics.
Did. Not painful. In general, simply a prick through the skin of the knee. If the doctor is experienced, then there is almost no pain, but simply not accepted. If not experienced, there may be a pain in the range of somewhere 2-3 on a five-point scale. But a couple of seconds of everything, if something touches inside.
I also did. Too not so it is sick. I know that anesthesia is not done in the usual case. In unusual (trauma, for example) - only if, for example, the blood in the joint begins to thicken. Then the medic can take the needle thicker.
Did a puncture a year ago. Something inside hurt, it was a little painful, but not for long. But the walk began immediately. No pain after the procedure was not. I do not know how others did to me when I was lying down. They did not anesthetize. Yes, I was normal.
A source: https://SkeletOpora.ru/terapii-i-diagnostika-nog/punktsiya-kolennogo-sustava