How to perform arthrocentesis of the elbow

Siamak Moayedi, MD
19th Nov 2020

Anatomy of the elbow

The elbow joint is found between the humerus, radius, and ulna. Using a lateral approach for arthrocentesis, you will access the elbow joint between the olecranon, the radial head, and the lateral epicondyle of the humerus.

Anatomy of an elbow joint: Side view of elbow with labels on the lateral epicondyle, olecranon, and radial head. Illustration.

Figure 1. Anatomy of an elbow. 

 

Ideal positioning for arthrocentesis of the elbow

For an elbow arthrocentesis, or elbow tap, you need to properly position your patient:

  • The patient is sitting down 
  • The affected elbow is flexed at 90° 
  • The hand is pronated (face down) on the surface  

Image of positioning of elbow for arthrocentesis. Male patient sitting down with arm resting on table. Cartoon.

Figure 2. Ideal positioning of the elbow for arthrocentesis. The patient is sitting down with the affected elbow flexed at 90°. The hand is pronated on the surface. 

Pronating the hand will move the radial head out of the way of the elbow joint. 

 

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How to perform arthrocentesis of the elbow

The arthrocentesis procedure requires six simple steps to ensure a safe, clean, and painless elbow tap: 

  1. Direct your 20 gauge (G) needle between the lower part of the radial head and the lateral epicondyle of the humerus, being sure to stay above the olecranon.
  2. Keep the needle parallel to the surface, and perpendicular to the arm (lateral approach). 
  3. Aspirate as soon as your needle enters the skin. 
  4. Stop advancing the needle when you see fluid. 
  5. Extract the joint fluid.
  6. Take the needle out and apply a bandage.

How to perform arthrocentesis of the elbow: Elbow with bony structure depicted. Icon of 20 gauge needle, arrow. Cartoon.

Figure 3. How to perform arthrocentesis of the elbow. 1) Insert the needle between the radial head and epicondyle, above the olecranon. 2) Keep your needle parallel to the bed and perpendicular to the arm. 3) Aspirate as soon as the needle enters the skin. 4) Advance the needle until the syringe fills with fluid. 5) Extract the fluid. 6) Take the needle out, and apply a bandage.  

Fantastic job! You have covered the basics of an elbow arthrocentesis procedure.

 

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Recommended reading

  • Roberts, J. 2019. “Arthrocentesis”. In: Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th edition. Philadelphia: Elsevier.