20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance

Name of the Procedure:

Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); without ultrasound guidance

Summary

Arthrocentesis is a procedure used to withdraw fluid from a small joint or bursa, typically in the fingers or toes. The procedure can also include an injection to deliver medication directly into the joint. This specific version of the procedure is performed without the aid of ultrasound guidance.

Purpose

The primary purpose of arthrocentesis is to relieve pain and swelling in small joints or bursae caused by conditions such as arthritis, gout, or infection. It may also be done to diagnose certain joint disorders by analyzing the withdrawn fluid.

Indications

• Persistent joint pain or swelling
• Suspected joint infection or inflammation
• Diagnosis and monitoring of various types of arthritis, including gout and rheumatoid arthritis
• Accumulation of fluid (effusion) in the joint

Preparation

• No specific fasting is generally required.
• Patients may be advised to stop taking certain medications that could increase bleeding risks.
• Pre-procedure assessments might include blood tests or imaging studies to evaluate the joint's condition.

Procedure Description

1. The patient's skin over the small joint or bursa is cleaned with an antiseptic solution.
2. A sterile needle is inserted into the joint space or bursa.
3. Fluid is aspirated (withdrawn) from the joint using a syringe attached to the needle.
4. If needed, medication (e.g., corticosteroids) is then injected into the joint.
5. The needle is withdrawn, and the area is cleaned again and possibly covered with a small bandage.

Equipment used includes:

• Sterile needles and syringes
• Antiseptic solution
• Bandages

This procedure is often done under local anesthesia to numb the area and minimize discomfort.

Duration

The procedure typically takes about 15-30 minutes.

Setting

Arthrocentesis is usually performed in an outpatient clinic or a doctor's office.

Personnel

• Physician (e.g., rheumatologist, orthopedic surgeon, general practitioner)
• Nurse or medical assistant to assist with preparation and aftercare

Risks and Complications

• Infection at the injection site
• Bleeding or bruising
• Temporary pain or discomfort at the insertion site
• Introduction of air into the joint space
• Rarely, damage to structures within the joint

Benefits

• Immediate relief from pain and swelling
• Improved joint function and range of motion
• Accurate diagnosis through fluid analysis
• Rapid onset of symptom relief when medications are injected

Recovery

• Patients can typically resume normal activities shortly after the procedure.
• Follow-up appointments may be needed to assess the joint and response to treatment.
• Patients should monitor the injection site for signs of infection (redness, heat, swelling).

Alternatives

• Oral or topical medications for pain and inflammation
• Physical therapy
• Advanced imaging-guided joint injections
• Surgical options for severe joint issues

Each alternative has its own set of pros and cons, which should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient may feel a slight pinch or pressure as the needle is inserted. Afterward, there might be some soreness at the site of the injection, but this typically resolves within a few days. Pain relief and improved joint function are often noticeable shortly after the procedure. Pain management techniques can include over-the-counter pain relievers and ice application.