title: Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?
abstract: OBJECTIVE
  The present randomized controlled trial compared arthrocentesis of the effusive knee followed by corticosteroid injection performed by the conventional anatomic landmark palpation-guided technique to the same procedure performed with ultrasound (US) needle guidance.
  
  
  METHODS
  Sixty-four palpably effusive knees were randomized to (i) palpation-guided arthrocentesis with a conventional 20-mL syringe (22 knees), (ii) US-guided arthrocentesis with a 25-mL reciprocating procedure device (RPD) mechanical aspirating syringe (22 knees), or (iii) US-guided arthrocentesis with a 60-mL automatic aspirating syringe (20 knees). The one-needle two-syringe technique was used. Outcome measures included patient pain by the Visual Analogue Scale (VAS) for pain (0-10 cm), the proportion of diagnostic samples, synovial fluid volume yield, complications, and therapeutic outcome at 2 weeks.
  
  
  RESULTS
  Sonographic guidance resulted in 48% less procedural pan (VAS; palpation-guided: 5.8 ± 3.0 cm, US-guided: 3.0 ± 2.8 cm, p < 0.001), 183% increased aspirated synovial fluid volumes (palpation-guided: 12 ± 10 mL, US-guided: 34 ± 25 mL, p < 0.0001), and improved outcomes at 2 weeks (VAS; palpation-guided: 2.8 ± 2.4 cm, US-guided: 1.5 ± 1.9 cm, p = 0.034). Outcomes of sonographic guidance with the mechanical syringe and automatic syringe were comparable in all outcome measures.
  
  
  CONCLUSIONS
  US-guided arthrocentesis and injection of the knee are superior to anatomic landmark palpation-guided arthrocentesis, resulting in significantly less procedural pain, improved arthrocentesis success, greater synovial fluid yield, more complete joint decompression, and improved clinical outcomes.
authors: Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. wsibbitt@salud.unm.edu
authors: W L
authors: WL
authors: Sibbitt
authors: L G
authors: LG
authors: Kettwich
authors: P A
authors: PA
authors: Band
authors: N R
authors: NR
authors: Chavez-Chiang
authors: S L
authors: SL
authors: DeLea
authors: L J
authors: LJ
authors: Haseler
authors: A D
authors: AD
authors: Bankhurst
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000000981:diagnostic imaging*; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010147:Pain Measurement; D010173:Palpation; D019152:Paracentesis / Q000379:methods*; D013582:Synovial Fluid / Q000378:metabolism; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000305:Adrenal Cortex Hormones