The ultrasound probe should have a sterile probe cover to ensure proper sterile technique. When using an ultrasound, the patient is positioned in a similar palmar flexed fashion. Ultrasound is a helpful tool to identify joint effusions and perform arthrocentesis. Once completed, the needle should be removed, and light pressure should be applied to the insertion site. The synovial fluid obtained should be transferred to specimen tubes testing for cell count, glucose, protein, LDH, lactate, crystals, and culture. If medication is to be injected, the syringe has to be removed while keeping the needle secure and the medication injected. If resistance is noted, rotating the needle or withdrawing it slightly could be helpful. Some resistance might be noted determined by the needle size, viscosity of the fluid, amount of fluid, and presence of fibrin clots. Upon entering the joint space, a pop or give is felt. The needle is inserted dorsally in a radial direction. The joint space in this approach is identified by palpating distal to the distal ulna. The ulnar approach uses the same positioning. If the needle hits the bone, then it should be withdrawn and redirected towards the thumb. For the radial approach, the needle should be inserted dorsally perpendicular to the skin. The joint space can be palpated distal to the distal radius and ulnar to the anatomic snuffbox, making sure to avoid the associated extensor tendons. The landmarks need to be palpated prior to cleansing the skin.
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