Gelenkpunktion

Gelenkpunktion, known in English as arthrocentesis, is a medical procedure in which synovial fluid is aspirated from a joint using a needle and syringe. It serves diagnostic purposes, such as evaluating joint effusions for infection, crystal arthritis, or inflammatory disease, and therapeutic purposes, such as relieving pressure or delivering medications.

The procedure is performed under sterile conditions, usually with the patient in a seated or supine position. After skin disinfection and local anesthesia, a sterile needle is inserted into the joint space. Fluid is aspirated for laboratory analysis, including appearance, white blood cell count, Gram stain and culture, and crystal analysis to identify monosodium urate or calcium pyrophosphate crystals; in some cases, inflammatory markers or LDH. Depending on indication, additional medications such as corticosteroids or antibiotics may be injected. Ultrasound or fluoroscopic guidance may improve accuracy, especially for small joints.

Indications include acute or chronic joint effusion with suspected infection, crystal arthropathy (gout, pseudogout), inflammatory arthritis, or to drain excessively accumulating effusion to relieve pain.

Risks are generally low but include infection, bleeding, pain, injury to surrounding structures, and transient joint discomfort. Contraindications include overlying skin infection, known septic arthritis in the joint, uncontrolled anticoagulation, or lack of patient consent.

Postprocedure care involves wound care, cold compression, rest of the joint, and monitoring for signs of infection. Results guide treatment decisions, antibiotic therapy if infection is suspected, or anti-inflammatory treatment if crystal or inflammatory disease is identified.