20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

Name of the Procedure:

Arthrocentesis (Aspiration and/or Injection) of Major Joint or Bursa with Ultrasound Guidance, including Permanent Recording and Reporting. Also known as joint aspiration and joint injection.

Summary

Arthrocentesis is a medical procedure where a needle is inserted into a major joint or bursa (such as the shoulder, hip, knee, or subacromial bursa) to remove fluid (aspiration) or inject medication. Ultrasound guidance is used to ensure accurate needle placement. The procedure is recorded and documented for medical records.

Purpose

This procedure addresses conditions like joint swelling, pain, and inflammation due to various causes, such as arthritis or bursitis. The goals are to relieve pain, diagnose the cause of joint problems through fluid analysis, and deliver medication directly into the joint.

Indications

• Persistent joint swelling or pain.
• Suspected joint infection or inflammation.
• Diagnostic evaluation of joint fluid.
• Chronic conditions like arthritis requiring medication injections.
• Evaluation and treatment of bursitis.

Preparation

• Patients may be advised to fast if sedation is planned.
• Adjustments to blood-thinning medications might be recommended.
• Basic diagnostic tests like blood work may be conducted.
• Ensure the skin around the joint is clean to prevent infection.

Procedure Description

1. The patient is positioned to allow easy access to the affected joint.
2. The skin over the joint is cleaned and sterilized.
3. Ultrasound is used to visualize the joint.
4. Local anesthesia is administered to numb the area.
5. A needle is inserted into the joint space, guided by ultrasound.
6. Fluid is aspirated for diagnostic testing or to relieve pressure and pain.
7. Medications, such as corticosteroids, may be injected if required.
8. The procedure is recorded and the information documented.

Duration

The procedure typically takes about 15 to 30 minutes, depending on the complexity.

Setting

Performed in an outpatient clinic, hospital, or surgical center equipped with ultrasound technology.

Personnel

• Orthopedic surgeons or rheumatologists.
• Radiologists or ultrasound technicians.
• Nurses and medical assistants.
• Anesthesiologists if sedation is needed.

Risks and Complications

• Infection at the needle insertion site.
• Bleeding or hematoma formation.
• Possible allergic reactions to medications.
• Joint damage or adverse reaction to the injected substance.
• Temporary pain or discomfort during and after the procedure.

Benefits

• Immediate relief of joint pain and swelling.
• Accurate diagnosis of joint conditions through fluid analysis.
• Effective delivery of medications directly to the problem area.
• Minimized risk of complications with ultrasound guidance.

Recovery

• Patients might need to rest the joint for a short period.
• Ice packs and pain relievers may be used to manage post-procedure discomfort.
• Avoid strenuous activities for a few days.
• Follow-up appointments to assess the effectiveness and monitor for complications.

Alternatives

• Oral or systemic medications for joint pain and inflammation.
• Physical therapy exercises.
• Surgical interventions for severe joint issues.
• Pros include non-invasiveness of oral medications; cons include longer time for relief and potential systemic side effects.

Patient Experience

During the procedure, patients may feel pressure or slight discomfort when the needle is inserted, which should be minimal due to local anesthesia. After the procedure, some soreness can be expected, but it can be managed with over-the-counter pain relievers and ice packs. Most patients can resume normal activities soon after, following their healthcare provider's advice.