Musculoskeletal

  • Arthrocentesis (Elbow)
  • Arthrocentesis (Knee)
  • Compartment Pressure Measurement
  • Patellar Dislocation Reduction
  • Shoulder Joint Dislocation Reduction

Arthrocentesis (Elbow)

  • Background
    • Involves puncture of elbow joint and aspiration of synovial fluid for therapeutic or diagnostic purposes. 
  • Indications
    • Suspicion for septic arthritis or inflammatory causes such as gout, pseudogout, or rheumatologic disorders. May also be used to relieve pain and improve mobility. 
  • Contraindications
    • No absolute contraindications. Relative contraindications include overlying skin infection, joint prosthesis, bacteremia, or anticoagulant use. Do not inject steroids into joint if infection is suspected.
  • Complications
    • Infection (rare), hemarthrosis, allergic reaction to anesthetic.
Video Credit: EM:RAP

*Deep Dive: Elbow Arthrocentesis (StatPearls)



Arthrocentesis (Knee)

  • Background
    • Involves puncture of knee joint and aspiration of synovial fluid for therapeutic or diagnostic purposes. 
  • Indications
    • Suspicion for septic arthritis or inflammatory causes such as gout, pseudogout, or rheumatologic disorders. May also be used to relieve pain and improve mobility. 
  • Contraindications
    • No absolute contraindications. Relative contraindications include overlying skin infection, joint prosthesis, bacteremia, or anticoagulant use. Do not inject steroids into joint if infection is suspected.
  • Complications
    • Damage to cartilage if place improperly, infection (rare), small hemarthrosis
Video Credit: Medmastery

*Deep Dive: Is There Water on the Knee? Arthrocentesis in the ED (emDocs)



Compartment Pressure Measurement

  • Background
    • Procedure used to assess for compartment syndrome. 
  • Indications
    • Pain or paresthesia following fractures, crush injury, snake bites, burns, prolonged tourniquet, or infection.
  • Contraindications
    • No absolute contraindications. Avoid sites with overlying infection.
  • Complications
    • Pain, low risk of infection
Video Credit: EM:RAP

*Deep Dive: Compartment Pressure Measurement (WikEM)



Patellar Dislocation Reduction

  • Background
    • Reduction of patellar dislocation; common in athletes and adolescent women. Dislocation may be lateral (most common), horizontal, vertical, or intercondylar
  • Indications
    • Lateral/medial dislocations, especially if associated with vascular compromise.
  • Contraindications
    • Presence of proximal tibia or distal femur fracture.
  • Complications
    • Osteochondral fractures (rare)
Video Credit: Larry Mellick

*Deep Dive: Patellar Dislocation (Life in the Fast Lane)



Shoulder Joint Dislocation Reduction

  • Background
    • Reduction of anterior (most common), posterior, or inferior (rare) shoulder dislocation.
  • Indications
    • Uncomplicated, low force shoulder dislocations
  • Contraindications
    • Associated fractures of humeral neck or subclavicular/intrathoracic dislocations. Avoid multiple attempts in those with suspected nerve injuries or other common fractures (Hill-sachs deformity, bankart fracture, 
  • Complications
    • Rare, but include fractures, neurovascular injuries, or rotator cuff injuries (rare)
Video Credit: Larry Mellick

*Deep Dive: Shoulder Reduction Techniques (emDocs)


Brandon Simpson, PA-S2
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