20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting

Name of the Procedure:

Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting.

Summary

In this procedure, fluid is either removed from or injected into a joint or bursa using a needle, typically with the assistance of ultrasound imaging to ensure accuracy. The process is recorded for medical records.

Purpose

This procedure aims to alleviate pain, reduce swelling, or collect fluid for diagnostic purposes in joints or bursae such as the temporomandibular, wrist, elbow, ankle, and others. It can help diagnose and treat conditions like arthritis, bursitis, and certain joint infections.

Indications

• Persistent joint or bursa pain
• Swelling and inflammation in a joint or bursa
• Suspected infection or crystal arthropathy (e.g., gout)
• Need for corticosteroid or hyaluronic acid injection
• Patients with limited response to initial treatments

Preparation

• Follow fasting guidelines if anesthesia will be used.
• Notify the healthcare provider of any medications being taken, particularly blood thinners.
• Pre-procedure imaging (e.g., X-ray, MRI) may be required.
• An informed consent form will need to be signed.

Procedure Description

1. The patient is positioned comfortably, and the skin over the joint or bursa is cleaned thoroughly.
2. Ultrasound guidance is used to locate the exact site of fluid aspiration or injection.
3. Local anesthesia is administered to numb the area.
4. A sterile needle is inserted into the joint or bursa under ultrasound guidance.
5. Fluid is either aspirated (withdrawn) for diagnosis or treatment, or medications (e.g., corticosteroids) are injected.
6. The procedure is documented with permanent recording and reporting.

Duration

Typically, the procedure takes about 15-30 minutes.

Setting

The procedure is performed in an outpatient clinic or a hospital setting.

Personnel

• Orthopedic surgeon or rheumatologist
• Radiologist or sonographer for ultrasound guidance
• Nursing staff

Risks and Complications

• Infection at the injection site
• Bleeding or bruising
• Temporary increase in pain or swelling
• Nerve damage
• Allergic reaction to the medication

Benefits

• Pain relief and reduced inflammation
• Improved joint function
• Diagnostic information from the aspirated fluid
• Minimally invasive with a quick recovery

Recovery

• Apply ice to the area to reduce swelling.
• Rest the affected joint for 24-48 hours.
• Follow any specific medication or physical therapy guidelines given by the healthcare provider.
• Schedule follow-up appointments as advised.

Alternatives

• Oral or injectable medications
• Physical therapy
• Surgery in severe cases
• Each alternative has different risks, benefits, and effectiveness.

Patient Experience

Patients might feel pressure or mild discomfort during the needle insertion. Post-procedure, the area might be sore and slightly swollen. Pain can be managed with over-the-counter pain relievers and ice packs.