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98 7 Arthrocentesis Technique

7.6 Approaches

The approach that clinicians use to perform arthrocentesis of different joints can vary and has been
described by numerous authors (Clements 2006; Degner 2014). The following section/images
describe some of the more common approaches as well as our preferred methods for obtaining
joint fluid from appendicular joints. Recommended patient positioning, needle placement, and
structures to avoid are summarized in Table 7.2.

Table 7.2 Summary of arthrocentesis recommendations and structures to avoid by region.

Area Patient positioning Needle placement Structures to avoid Figure

Carpus Lateral recumbency with the From cranial, just Cephalic and Figure 7.1
(radiocarpal target joint/limb up below the palpable accessory cephalic
joint) distal radius vein
Elbow Medial aspiration Figure 7.2
Lateral recumbency with the From medial, distal, Ulnar nerve
target joint/limb down and caudal to the
medial epicondyle
Caudal aspiration
Lateral recumbency with the From lateral, in None
target joint/limb up between the lateral
epicondylar crest and
anconeal process
Shoulder Lateral recumbency with the Lateral aspiration Figure 7.3
target joint/limb up
From lateral, just Suprascapular
below (or slightly nerve
caudal to) the
acromion process
Cranial aspiration
From cranial, just Biceps tendon (if
medial or lateral to medial to greater
the greater tubercle tubercle)
Tarsus Lateral recumbency with the Cranial aspiration Figure 7.4
(tibiotarsal target joint/limb up
joint)
From lateral, just Cranial branch of
medial and cranial to lateral saphenous
the lateral malleolus vein
Caudal aspiration
From lateral, caudal Caudal branch of
to the lateral lateral saphenous
malleolus/distal tibia vein
Stifle Lateral recumbency with the From cranial, medial, Meniscus Figure 7.5
target joint/limb up or dorsal or lateral to patellar
recumbency with the target tendon
joint/limb facing the
clinician
Hip Lateral recumbency with the From lateral, just Sciatic nerve Figure 7.6
target joint/limb up proximal to greater
trochanter