Shoulder Arthrocentesis Technique

Shoulder arthrocentesis (shoulder aspiration) is a necessary and practical skill in the hands of emergency physicians, surgeons, medical specialists, and primary care providers. A clinically useful procedure for both diagnostic and therapeutic indications, shoulder joint aspiration as a diagnostic procedure limited relative contraindications. Shoulder aspiration/injection techniques are commonly utilized in various treatment and management modalities. Aspiration techniques are often used in clinical settings that require synovial fluid analysis to aid in the diagnosis of inflammatory or septic arthritis. In addition, shoulder aspiration techniques can be used in rheumatologic and traumatic causes, such as when attempting to clinically differentiate between suspected cases of infection versus gout, pseudogout, and/or traumatic hemarthroses. Therapeutically, the technique is utilized to aspirate (or "drain") shoulder joint effusions in addition to coupling the aspiration with the injection of a local steroid and/or anesthetic for pain relief and to facilitate shoulder reduction in an awake patient. The latter can be beneficial for the patient and help mitigate other risks associated with procedural sedation and IV pain medication use. Glenohumeral intra-articular injections can also be utilized in the setting of pain/symptomatic management of shoulder degenerative joint diseases.In the setting of clinical suspicion for periprosthetic joint infections (PJI), in this case following either a standard total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (rTSA), or a shoulder hemiarthroplasty, aspirations sent for extended culture incubation time periods (i.e. 2 to 3 weeks) can be clinically useful to aid clinicians in the appropriate management of these conditions.