What are the contraindications for wrist arthrocentesis?

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

Few absolute contraindications for joint or soft-tissue aspirations and injections exist.

If infection of the joint is suspected, fluid should almost always be aspirated from a joint. For other indications, the procedures should probably be avoided if infection is present in the overlying skin or subcutaneous tissues or if bacteremia is suspected.

The presence of a significant bleeding disorder or diathesis or the presence of severe thrombocytopenia may also preclude joint aspiration. If the procedure is deemed necessary for diagnosis or therapy, it may be carried out with appropriate precautions to address the bleeding disorder (eg, after an injection of factor VIII in a patient with hemophilia). Warfarin anticoagulation with international normalized ratio (INR) values in the therapeutic range is not a contraindication for joint or soft-tissue aspiration or injection.

Arthrocentesis through an area of irregular or disrupted skin (eg, psoriasis) should be avoided because of the increased numbers of colonizing bacteria in such areas.

Aspiration of a joint with a prosthesis in it carries a particularly high risk of infection and is often best left to surgeons using full aseptic techniques.

If infection is the suspected underlying cause of the musculoskeletal problem, corticosteroids should not be injected; if they are, the infection may be exacerbated.


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