20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance

Name of the Procedure:

Arthrocentesis, Aspiration and/or Injection, Major Joint or Bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance

Summary

Arthrocentesis is a medical procedure that involves the use of a needle to withdraw fluid from a major joint or bursa, such as the shoulder, hip, knee, or subacromial bursa. It can also involve injecting medication into the joint. This procedure is performed without the aid of ultrasound guidance.

Purpose

Arthrocentesis addresses conditions involving joint inflammation, swelling, or infection. It can help diagnose the cause of joint issues, relieve pain, reduce swelling, and improve joint function.

Indications

• Joint swelling or effusion
• Unexplained joint pain
• Suspected joint infection (septic arthritis)
• Gout or pseudogout
• Arthritis exacerbations
• Diagnostic evaluation of joint fluid

Preparation

• Patients may be advised to stop taking blood-thinning medications.
• No fasting is typically required.
• Diagnostic tests like blood work or imaging may be performed prior to the procedure.

Procedure Description

1. The patient is positioned to allow easy access to the affected joint or bursa.
2. The area is cleaned with an antiseptic solution to reduce infection risk.
3. A local anesthetic is applied to numb the area.
4. A needle is inserted into the joint or bursa to withdraw fluid (aspiration).
5. The fluid may be sent to a lab for analysis.
6. If needed, medication (e.g., corticosteroids) is injected into the joint to reduce inflammation.
7. The needle is removed, and a bandage is applied to the site.

Duration

The entire procedure typically takes about 15 to 30 minutes.

Setting

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

Personnel

• Orthopedic surgeon or rheumatologist
• Healthcare professionals such as nurses or medical assistants

Risks and Complications

• Pain or discomfort at the injection site
• Infection
• Bleeding or bruising
• Damage to the joint structures
• Allergic reaction to medications

Benefits

• Immediate pain relief
• Reduced swelling and inflammation
• Improved joint function
• Diagnostic information from the joint fluid analysis

Recovery

• Patients can usually return to their normal activities immediately, but strenuous activities should be avoided for a short period.
• Post-procedure care may include ice application to reduce swelling.
• Follow-up appointments may be needed to assess the procedure's effectiveness.

Alternatives

• Oral or injectable anti-inflammatory medications
• Physical therapy
• Imaging-guided injections
• Surgical intervention for severe cases

Patient Experience

During the procedure, patients may feel a pinch or pressure when the needle is inserted. Pain is typically minimal due to the local anesthetic. After the procedure, there may be mild soreness or bruising at the site, manageable with over-the-counter pain relievers.