What are the diagnostic indications for wrist arthrocentesis?

Updated: Nov 03, 2020
  • Author: Richard S Krause, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Diagnostic indications for wrist arthrocentesis include the following:

  • Suspicion of septic arthritis [4, 5] (mandatory)
  • Suspicion of crystal arthritis or hemarthrosis (strongly advised)
  • Differentiation of inflammatory and noninflammatory arthritis
  • Imaging studies (arthroscopy, arthrography)
  • Synovial biopsy

Aspiration and analysis of synovial fluid are helpful for diagnosis when septic arthritis, crystal synovitis, or bleeding is the suspected cause of a joint, bursal, or tendon sheath condition. In addition, in patients who have poorly defined forms of arthritis, knowledge of the nature of the synovial fluid, particularly the inflammatory cell content, complements findings from the history and physical examination and helps provide the basic framework for diagnosis and treatment (see Table 1 below).

Table 1. Assessment Parameters for Synovial Fluid (Open Table in a new window)

Parameter

Normal

Osteoarthritis

Rheumatoid and Other Inflammatory Arthritis

Septic Arthritis

Gross appearance

Clear

Clear

Opaque

Opaque

Volume, mL

0-1

1-10

5-50

5-50

Viscosity

High

High

Low

Low

Total white blood cell count, cells/μL

< 200

200-10,000

500-75,000

>50,000

Polymorphonuclear cells, %

< 25

< 50

>50

>75

Wrist arthrocentesis can be performed for diagnosis of acute arthritis. Most cases of acute wrist arthritis are due to calcium pyrophosphate dihydrate pseudogout, gout, and septic arthritis.


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