What are the contraindications for shoulder arthrocentesis?

Updated: Nov 27, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Answer

Bacteremia, cellulitis of overlying skin, and adjacent osteomyelitis are often considered absolute contraindications for shoulder arthrocentesis because of the potential risk of seeding the joint with bacteria. In these situations, the procedure should be performed only if the clinician strongly suspects septic arthritis as the cause of overlying inflammatory changes, and then only after consultation with an orthopedist.

Relative contraindications include glenohumeral joint infection, lack of effusion seen on ultrasonography (US), chronic infection distant to the injection site, prosthetic joints, allergy to the injectate, diabetes mellitus, and uncontrolled coagulopathy. Emergency arthrocentesis of a sterile joint may be required if a sterile environment is not available. [4]

"Allergies" to povidone-iodine, lidocaine, or latex are not absolute contraindications. The injection site can be cleaned with chlorhexidine or pHisoHex followed by alcohol pads. Latex allergies are typically local reactions. In severe latex allergies, the rubber stopper on the lidocaine must be removed. [5]


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