What is the role of aspiration and evaluation of joint fluid in the evaluation of tenosynovitis?

Updated: Nov 22, 2019
  • Author: Mark R Foster, MD, PhD, FACS; Chief Editor: Harris Gellman, MD  more...
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If infection is suggested, culture of the suppurative synovial fluid is mandatory before definitive antimicrobial treatment is initiated. These cultures should include aerobic, anaerobic, fungal, acid-fast bacilli (AFB), and atypical AFB samples. In nonsuppurative conditions, synovial fluid may show nonbirefringent crystals (gout) or birefringent crystals (calcium pyrophosphate disease [CPPD], or pseudogout).

Diagnostic arthrocentesis is indicated when joint effusion is present with tenosynovitis because most patients with disseminated gonococcal infection have coexistent septic arthritis. (Most gonococcal arthritis is monoarticular; approximately 25% of cases are polyarticular.) Characteristics of the aspirated fluid can include the following:

  • Sterile fluid is common with gonococcal arthritis; cultures are negative in 50% of patients
  • Joint fluid glucose is usually normal.
  • White blood cell (WBC) counts are usually below 50,000/μL
  • A Gram stain is positive in only 25% of patients

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