Using sonography to reveal and aspirate joint effusions.

1353 raditionally, joint aspiration has been performed using only external anatomic landmarks (“blind” aspiration) or fluoroscopic guidance. We illustrate the technique and role of joint aspiration of the shoulder, elbow, hip, knee, and ankle with sonographic guidance. Sonographic evaluation and guidance of aspiration offers several advantages over the traditional approaches. The joint can first be examined to determine if fluid is present. This examination can eliminate a potentially traumatic and unnecessary aspiration attempt of a joint that does not contain an effusion. In addition to joint effusions, sonography can reveal fluid collections, such as bursitis and soft-tissue abscesses, outside the joint. Many soft-tissue abscesses and distended bursae can be detected on physical examination. Not infrequently, however, there is a clinical question of an abscess in a patient with cellulitis, soft-tissue edema, or obesity that limits the physical examination. In such patients, there may also be a question of a joint effusion. Sonographic examination allows detection of joint fluid as well as soft-tissue fluid collections and avoids contamination of an aseptic joint that could occur by blind or fluoroscopic aspiration through an overlying soft-tissue infection such as an abscess, septic bursitis, or septic tenosynovitis.