Puncture of the shoulder joint: technique of performing

Puncture of the shoulder joint is a surgical procedure, during which the doctor enters the needle into the articular bag. Such a procedure is carried out for diagnostic purposes or for medical reasons. The purpose of this procedure is to reduce the amount of synovial fluid in the joint.

Two types of puncture

Surgeons subdivide punctures into two types:

• Healing.
• Diagnostic.

Anatomy of the joint

When performing puncture of the shoulder joint, it is necessary to take into account the characteristic features of his anatomy. The synovial membrane is a membrane, which in its structure and origin differs from membranes of serous (such as the membrane of the pleura, peritoneum, pericardium). The main difference is that its inner side, facing the surface cavity, does not contain epithelial cover and endothelial lining. The thickness of the membrane is not the same. In addition, it has increased sensitivity to thermal, traumatic, infectious and chemical influences.

Due to the increased sensitivity of the synovium to a variety of infections, strict adherence to asepsis before the puncture procedure and before opening the joint cavity is required. In addition, its mandatory sealing is necessary. The joint cavity contains a small amount of synovial fluid, about four milliliters. The synovial fluid is sterile, has a yellowish-straw color and is absolutely transparent at the same time. It is characterized by high viscosity, it contains phagocytes and leukocytes, but its bactericidal properties are very small. Because the synovial fluid is saturated with mucopolysaccharides with a high specific gravity, it accumulates in the joint, rather than diffuses out of its cavity.

The technique of performing a puncture of the shoulder joint will be considered below.

About the joint fluid

Get the joint fluid and not cause a pathological process is very difficult because of its small amount, negative pressure and increased viscosity. Healthy joints have a negative pressure:

• Ankle: 270-210 millimeters of water column.
• Knee joint: 75-90 millimeters of water column.

The presence of negative pressure causes osmosis of fluid from the subchondral and synovial plates, from which the cartilage tissue of the joint is fed.

Puncture of the shoulder joint in healthy people is performed in rare cases.

Functions of synovial fluid

The main functions of the synovial fluid are:

• Locomotor function. The synovial fluid in tandem with articular cartilage ensures free movement of articulated bone surfaces.
• Metabolic function. Synovial fluid takes part in the metabolic processes that occur between the vascular bed and the joint fluid.
• Trophic function. The synovial fluid nourishes the avascular layers of the cartilage.

If there is an inflammatory process in the joint, then in the synovial fluid the protein content increases. This is due to increased vascular permeability. The liquid becomes turbid, it increases the neutrophilic leukocyte count as a result of acute traumatic synovitis.

Puncture of the shoulder joint: indications

• Determination of the content of the contents (for the presence of pus, exudate or blood in it). If the damaged joint contains blood, then there may be synovitis, cartilage damage degenerative-dystrophic nature, intraarticular spikes. In the case of traumatic hemarthrosis, the stiffness and inflammation of the adhesive character is caused more by damage to the cartilage thickness, and not by the action of the bleeding blood. Regeneration of cartilaginous tissue occurs with changes in proliferative character in connective tissue. In the case of damage to the cladding, blood coagulation takes place quickly enough, and then clots form which can lead to a significant proliferation of the shell tissues. As a result, obliteration of the joint cavity begins.
• The establishment of meniscus lesions in the knee joint using pneumoarthrography or radiography.
• Establishment of the presence of "rice bodies" or "articular mice" in the joint cavity.

For this, a diagnostic puncture of the shoulder joint is prescribed.

Indications for the procedure of puncture treatment type

• Removal of blood during the development of hemarthrosis.
• Removal of exudate, pus from the joint cavity, administration of solutions of antibiotics.
• The introduction of novocaine solution when dislocating the dislocation.
• The introduction of corticosteroids in combination with lidase in the presence of deforming arthrosis.
• Introduction of oxygen or air for a gentle procedure for the destruction of articular adhesions formed in the case of fibrous fusion. The introduction of oxygen is also possible for the purpose of restoring the motor function or for stage-by-stage redress.

For this purpose, puncture of the shoulder and knee joints can be performed.

Performing the procedure

Due to the extreme sensitivity of synovial fluid to infections, when performing joint puncture, one should adhere to all the rules of antiseptics and asepsis.

Before the puncture, the puncture site should be carefully decontaminated. It will be advisable to use seventy percent alcohol. After the skin at the puncture site was lubricated with a 5% iodine solution, its residues should be removed by double rubbing with alcohol. Removal of iodine residues, especially with abundant lubrication, is required because iodine along with the needle can penetrate into the joint cavity, and this causes irritation of the synovial membrane and a severe burn reaction. Among other things, iodine can absorb X-rays, and this can affect the reliability of the picture - it may display distorting images additional shadows.

Use local infiltration anesthesia.

How do they make a puncture?

The length of the needle for a puncture is 5-6 centimeters. If oxygen is introduced, the needle should be used thin, up to one millimeter in diameter. Otherwise, the gas can penetrate into the soft tissues surrounding the joint. That, in turn, provokes subcutaneous, periarticular or muscular emphysema.

The skin at the puncture point of the shoulder joint should be pushed to the side. This allows you to curl the wound channel left by the needle, and after the procedure, the skin is returned to its place. This technique allows to avoid infection from the surface of the body into the joint cavity.

The needle should be moved very slowly, trying to determine when its end will pass into the articular bag. If there is blood in the articular cavity, there will be a staining of the novocaine solution in the syringe, and if the pus, the solution becomes cloudy.

In regard to the depth with which it is necessary to carry out a puncture, there are different opinions. Some literature says that the needle should penetrate a maximum of one centimeter, and the other - at 2-3 centimeters.

Liquid for puncture must be sucked off with a syringe with a volume of 10 to 20 grams. If required, drugs are administered. After removing the needle, the displaced skin is released, thereby curving the wound channel, then the puncture site is treated with alcohol and a sterile bandage is applied.

Technique of puncture of the shoulder joint

Puncture of this joint should be carried out laterally, in front or behind. If the procedure is carried out from the front, the patient should be placed on his back. After this, the surgeon must grope for the coracoid scapula, which is three centimeters lower than the distal end of the clavicle. The needle should be inserted under it and lead between the head of the bone of the shoulder and its process in the direction from front to back. The needle is introduced to a depth of 4 centimeters.

If the puncture of the shoulder joint is performed by the surgeon on the side, the patient must be placed on the opposite side, and his arm placed strictly along the trunk. At the width of the finger a little lower from the large tubercle is the head of the humerus, its heads. The needle is worthy to work under that part of the acromial process, which is the most protruding, and then move it through the deltoid muscle in the frontal plane.

When performing the puncture procedure, the patient should be placed on the stomach. After this, the surgeon gropes for the deltoid muscle and its lower edge. In this place there is a fovea, located slightly lower than the posterior edge of the acromial process. In this place, you need to stab the needle and insert it to a depth of 5 centimeters in the direction of the coracoid scapula of the scapula.