Perforated flexible catheters improve joint fluid aspiration in shoulder cadavers.

A fluoroscopically controlled anterior approach in supine position is often used for arthrocentesis of the shoulder, but can lead to a high rate of dry aspirations. The aim of this study was to compare the aspiration performance of rigid needles and flexible catheters used with this approach. We hypothesized that a flexible catheter can significantly improve the amount of the obtained fluid. The glenohumeral joint of ten human cadaveric shoulder specimens were sequentially filled with 5, 10, 20 and 30 mL of contrast agent. For each volume the maximum aspirated amount of contrast agent with 4 different aspiration devices (20 gauge needle, 16 gauge needle, 16 gauge flexible catheter and 16 gauge perforated flexible catheter) were compared. All aspirations were done in supine cadaver position from anterior under fluoroscopic control. The aspirated amount of fluid was significantly higher using the 16 gauge perforated flexible catheter (p = 0.002-0.028) compared with all other devices when 5, 10 and 20 mL of contrast agent were in the joint. This perforated flexible catheter aspirated 80-96% of the available fluid while the standard 20 gauge needle aspirated 40-60%. Using a 16 gauge perforated flexible catheter in a supine anterior arthrocentesis technique results in aspiration of most of the fluid in human cadaveric shoulder specimens, while standard needles aspirate only about 50% of it. This can be clinically relevant when there is very little synovial fluid available and might reduce the number of insufficient aspirations.

The use of arthrocentesis in patients with temporomandibular joint disc displacement without reduction.

The aim of this study was to evaluate the efficacy of the use of the arthrocentesis in patients with disc displacement without reduction (DDWOR). Two hundred and thirty-four (234) patients with DDWOR were evaluated and the following data collected: gender; affected side; age (years); duration of the pain (months); patient's perception of pain (measured by Visual Analogue Scale [VAS 0-10]); maximal interincisal distance (MID) (mm); and joint disc position, determined by magnetic resonance imaging. Data were obtained in two different moments: before the arthrocentesis (M1) and three or four months later (M2). Paired t-Student Test, Scores Test and Wilcoxon Test showed a statistical significant difference (p<0.0001) between the M1 and M2 for the variables VAS and MID. There was an alteration in the joint disc position in 93.88% of the cases after arthrocentesis. There was no association between the general characteristics of the patients on the M1 and the results of the arthrocentesis (p>0.05). It can be concluded that the arthrocentesis is efficient in reducing the pain, in increasing interincisal distance, and altering the joint disc position in patients with DDWOR regardless gender, age side and pain duration.

Double puncture versus single puncture arthrocentesis for the management of unilateral temporomandibular joint disc displacement without reduction: A randomized controlled trial.

PURPOSE: To compare the clinical efficacy of the conventional double puncture versus single puncture type 2 arthrocentesis for management of temporomandibular joint disc displacement without reduction (DDWOR). MATERIALS AND METHODS: Twenty-six patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 13): Group 1, conventional double puncture arthrocentesis; Group 2, single puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID - mm), and pain intensity self-reported with a visual analog scale (VAS; 0-10) were collected. VAS scores and MID were measured before (baseline) and 6 months after arthrocentesis (final). RESULTS: Both techniques resulted in significantly reduced VAS scores and increased MID (p = 0.001) after 180 days. However, there were no statistically significant differences between techniques (p > 0.05). CONCLUSIONS: The two arthrocentesis methods tested were effective in reducing VAS scores and increasing MID in patients with DDWOR.

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review.

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well-designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.

The Double Intravenous Catheter Technique for Single-Puncture Arthrocentesis.

Traditionally, arthrocentesis involves insertion of 2 needles into the joint space of which one acts as an inflow port and the other as the outflow port. These 2 needles must triangulate and be exactly placed in the upper joint space for the procedure to be effective. Due to the difficulty in maintaining the needle position, single-puncture arthrocentesis is gaining popularity. It is relatively easier to perform and less traumatic to the joint. The authors describe a simple technique of single-puncture arthrocentesis using parts of 2 peripheral intravenous catheters of different gauges. The outflow port is formed by the catheter tube of 1 cannula while the inflow port is formed by the needle of the second cannula. Besides beings easy to perform and cost-effective, our technique provides predictable joint lavage of the joint with minimal trauma to the tissues.

Comparison of the efficiency of irrigation of single and double-needle techniques of temporomandibular joint arthrocentesis: A cadaver study.

OBJECTIVE: To compare the efficacy of the double- and single-needle arthrocentesis techniques in removing methylene blue from the temporomandibular joint (TMJ) space. METHODS: This study was performed in 20 TMJs from 10 fresh cadavers. A total of 1 ml of 10 µM methylene blue solution was injected into the upper joint spaces, just prior to irrigation. Ten arthrocentesis procedures were carried out using the double-needle technique, and the remaining 10 were completed using the single-needle technique. The photo-absorbance values of methylene blue solution injected into and removed from the joint space were measured at a 665 nm wavelength. Statistical analysis was performed using Shapiro-Wilks test and t-test. RESULTS: The t-test analysis showed no statistically significant difference between the two methods in the removal of methylene blue. CONCLUSION: According to the results of the present study, the single-needle technique may be a good alternative with the advantages of easier application in cases where it is not possible to perform the double-needle technique.

Use of Ultrasound by Internists to Improve Diagnostic Small Joint Aspiration.

BACKGROUND: Primary care internists are often the first to see patients with an initial episode of crystalline arthritis. Timely aspiration of the affected joint for definitive diagnosis and treatment in the office is desirable but can be difficult, especially if the joint is small, surrounded by soft tissue swelling distorting landmarks, and is very painful to move or palpate. METHODS: We compared the likelihood of successful aspiration of the great toe metatarsophalangeal joint by primary care internists for the diagnosis of potential crystalline arthritis by either landmark identification of the joint space or by employing ultrasound to identify the joint space. RESULTS: Aspiration was performed by one of 2 primary care internists using landmarks and palpation to identify the joint space in 27 patients with suspected crystalline arthritis affecting the first metatarsophalangeal joint. A sample adequate for diagnosis by polarized light microscopic crystal analysis was obtained in 14 of the 27 aspirations (52%) when landmarks alone were used to locate the joint space. In an additional 27 patients with suspected crystalline arthritis affecting the first metatarsophalangeal joint, ultrasound was used to identify the joint space and resulted in a significant increase in the success of obtaining an adequate diagnostic sample, which was obtained in 25 of the 27 aspirations (93%). CONCLUSIONS: The primary care internist can easily provide quality and timely small joint diagnostic aspiration when ultrasound is used to identify the location of the joint space.

Success of ultrasound-guided versus landmark-guided arthrocentesis of hip, ankle, and wrist in a cadaver model.

PURPOSE: The objectives of this study were to evaluate emergency medicine resident-performed ultrasound for diagnosis of effusions, compare the success of a landmark-guided (LM) approach with an ultrasound-guided (US) technique for hip, ankle and wrist arthrocentesis, and compare change in provider confidence with LM and US arthrocentesis. METHODS: After a brief video on LM and US arthrocentesis, residents were asked to identify artificially created effusions in the hip, ankle and wrist in a cadaver model and to perform US and LM arthrocentesis of the effusions. Outcomes included success of joint aspiration, time to aspiration, and number of attempts. Residents were surveyed regarding their confidence in identifying effusions with ultrasound and performing LM and US arthrocentesis. RESULTS: Eighteen residents completed the study. Sensitivity of ultrasound for detecting joint effusion was 86% and specificity was 90%. Residents were successful with ultrasound in 96% of attempts and with landmark 89% of attempts (p=0.257). Median number of attempts was 1 with ultrasound and 2 with landmarks (p=0.12). Median time to success with ultrasound was 38s and 51s with landmarks (p=0.23). After the session, confidence in both US and LM arthrocentesis improved significantly, however the post intervention confidence in US arthrocentesis was higher than LM (4.3 vs. 3.8, p<0.001). CONCLUSIONS: EM residents were able to successfully identify joint effusions with ultrasound, however we were unable to detect significant differences in actual procedural success between the two modalities. Further studies are needed to define the role of ultrasound for arthrocentesis in the emergency department.

Custom-made mouth prop for TMJ arthrocentesis: a technical note.

INTRODUCTION: TMJ arthrocentesis involves lavage of the upper joint space which forces the disc apart from the fossa and washes away the inflammatory components of the joint. To increase the joint space during arthrocentesis, the patient is usually asked to open the mouth and deviate it to the opposite side so as to distract the condyle from the glenoid fossa thereby increasing joint space. METHOD: The authors describe a simple and rapid technique of preparing a custom-made mouth prop to hold the mandible in eccentric position during arthrocentesis. FINDINGS: The custom-made mouth prop is an effective tool to help relax the patient in an eccentric position during the duration of arthrocentesis procedure.

A single-puncture arthrocentesis technique, using a peripheral intravenous catheter.

Arthrocentesis is a technique used for lavage of the inflammatory content of the supradiscal space and lysis of the fibrous strands attaching the articular disc to the superior compartment of the temporomandibular joint (TMJ). The most widely accepted and classical manner in which this technique is performed is through two-needle access to the superior joint space. Nevertheless, it has been reported in the literature that this technique is challenging and has several limitations. Thus, the use of a single-puncture approach has been proposed, which represents a less traumatic and easier to perform technique. The single-puncture approach may have several advantages over the classical two-needle approach in regard to completion time, tolerability, stabilization of the needle, and retention of the intra-articular medication. A single-puncture technique is described herein, which uses an intravenous catheter to provide simultaneous inflow/outflow for low or high volume irrigation of the TMJ. The feasibility and low cost of this technique are primary advantages; peripheral intravenous catheters are one of the most widely used devices for vascular access in the primary and hospital healthcare settings.

[How to do: joint puncture]. / Die Gelenkpunktion.

Arthrocentesis is a targeted way to an exact diagnosis and efficient therapy. The procedure is poor in complication.

Single-needle arthrocentesis (Shepard cannula) vs. double-needle arthrocentesis for treating disc displacement without reduction.

OBJECTIVES: To compare single- vs. double-needle arthrocentesis with viscosupplementation for treating disc displacement without reduction of the temporomandibular joint. METHODS: Fifty-six patients with a magnetic resonance imaging diagnosis of non-reducing disc displacement were included. Arthrocentesis with viscosupplementation was performed on patients in group I using the Y-shaped needle (Shepard cannula) technique; the standard double-needle technique was performed on patients in group II. Patients were evaluated on postoperative day 1, and 1, 3, and 6 months later, patient- and procedure-related parameters were assessed. RESULTS: In both groups, significant improvement in the baseline levels was achieved (p < 0.01). Both techniques were equally effective at reducing pain and increasing the maximal mouth opening. The single-needle technique was easier to perform and required a shorter operative time (p < 0.01). DISCUSSION: Single-needle (Shepard cannula) arthrocentesis can be an alternative to the standard technique; however, it might add to the cost of the procedure.

Long-Term Outcome of Arthrocentesis Plus Hyaluronic Acid Injection in Patients With Wilkes Stage II and III Temporomandibular Joint Internal Derangement.

OBJECTIVE: Arthrocentesis is a minimally invasive procedure used to manage temporomandibular joint (TMJ) internal derangement (ID). This study evaluated the outcome of arthrocentesis in patients with Wilkes stage II and III TMJ ID. PATIENTS AND METHODS: This retrospective study enrolled 50 patients who underwent arthrocentesis in 2011 and 2012 at the Karadeniz Technical University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Turkey. In total, 43 patients underwent unilateral arthrocentesis, whereas 7 patients had bilateral arthrocentesis. The clinical parameters recorded were pain (visual analogue scale [VAS] 0-100 mm during movement), chewing function efficacy (VAS 0-100), clicking sounds, and mandibular movements, including maximum interincisal opening (MIO), lateral excursion, and protrusion. All the parameters were recorded preoperatively, and 1, 3, 6, and 24 months after treatment. RESULTS: The MIO, lateral excursion, and protrusion were significantly greater than preoperatively in all the patients. Pain declined significantly postoperatively. The patients in Wilkes III group had greater improvement in mandibular movement and pain than the patients in Wilkes II group. CONCLUSION: Arthrocentesis was reliable for treating both Wilkes II and III TMJ ID, and the treatment results were better in Wilkes III patients.

Signs and symptoms after temporomandibular joint washing and cannula placement assessed by cone beam computerized tomography.

OBJECTIVE: Analyses of temporomandibular joint synovial fluid using the hydroxocobalamin push-pull technique are increasingly used. However, objective complications and subjective experiences from this procedure have not been described. Firstly, this study aimed to describe discomfort and potential side-effects of this method with special emphasis on symptoms related to the arthrocentesis to be used for future patient information and Ethical Committee applications. Secondly, this study aimed to evaluate the use of cone beam computed tomography (CBCT) as control of intra-capsular cannula placement. METHODS: Twenty healthy, young adult volunteers were included. Extensive objective and subjective questionnaires were completed before and 14 days after the synovial fluid sampling. With the cannula inside the joints a CBCT was done to investigate if this procedure can be used to verify intra-capsular cannula position. RESULTS: The subjective findings: Most subjects did experience mild pain or discomfort post-operatively. In 12 of 20 subjects symptoms had resolved after 2 days and no subjects had symptoms for more than a week. The longer lasting symptoms were mainly transient joint sounds on mandibular movement. Objective findings: 14 days after the sampling mandibular protrusion had improved 1 mm, but all other objective measures were equal compared to baseline. CBCT showed a large variation in cannula position and no conclusions could be drawn from this. CONCLUSION: The hydroxocobalamin push-pull synovial fluid sampling may cause minor, transient symptoms. CBCT does not seem to provide any clinical benefits concerning the correct cannula position in relation to the upper joint compartment and disc.