Question 2 of 13

Which of the following techniques of joint aspiration is correctly described?

Knee: lateral to the distal edge of the patella, aim a 27-gauge needle in an inferior and cephalad direction, use 1% lidocaine with epinephrine.

Wrist: dorsal wrist, superior to the ulnar styloid process, aim a 20-gauge needle just distal to the radial notch, use 1% lidocaine with epinephrine.

First metatarsal–phalangeal joint: plantar surface of foot, aim a 20-gauge needle at the joint space just to the side of the extensor hallucis tendon, use 1% lidocaine with epinephrine.

Shoulder: anterior shoulder, 2 cm medial to the acromial process, aim in cephalad direction with an 18-gauge needle, use 1% lidocaine with or without epinephrine.

Elbow: lateral elbow, between the lateral epicondyle and the olecranon, aim toward the patient's thumb, use 1% lidocaine without epinephrine.

The most devastating complication of joint aspiration is infection. Aspirations should not be made through areas of cellulitis or bursitis. Other complications are infrequent (e.g., transient arm numbness in shoulder aspirations from inadvertent anesthesia of the brachial plexus). Lidocaine with epinephrine should not be used for anesthesia when aspirating the joints of the fingers or the toes: the digits are supplied by end arteries and ischemic injury may result.

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