Edited by Phil Grisdela and Matt Fury - 7/1/2021
Indications/Contraindications
Rule out septic arthritis of the elbow.
Workup as standard: Infectious source (immunocompromised? IVDU? Positive blood cultures?), XR rule out fracture or dislocation, WBC, ESR/CRP
Exam: For septic arthritis of the elbow, the painful motion is pronation and supination of the elbow joint - this isolates the radiocapitellar joint. Looking to make sure there isn’t a septic bursitis, which would be still painful but with flexion/extension
Materials/positioning
18g spinal needle
Chlorhexidine/alcohol wipes
Red top
Purple top
Lab/specimen bag
10cc syringe
Technique
Prep the area, looking for the “triangle” between the radial head (feel this as you pronate and supinate the forearm), lateral epicondyle and olecranon tip - there should be a soft area in the middle
Pronate and flex the elbow to prevent damage to the radial nerve
Pearls & Pitfalls
Dry tap common complication, pronate the elbow and flex to 90 to avoid radial nerve damage. Don’t go from the ulnar side as the cubital tunnel and ulnar nerve lie adjacent to the joint.
Put in orders for joint aspiration first (Stat gram stain and culture go in the red top, cell count, crystals go into the purple top), let nurse know so they can print out the labels while you nail the tap. Walk the tubes to the lab yourself.