Abstract
Information about the distribution of effusion within the arthritic knee joint should be considered in selecting an anatomical approach for arthrocentesis. We recorded ultrasound measurements of fluid distribution in the knees of patients attending our clinic for knee injections under ultrasound guidance. In a cross-sectional observational study, we used high-resolution ultrasound (US) to record measurements of maximum fluid depth in the medial, midline and lateral regions of the suprapatellar pouch (SPP) in 46 patients with arthritis attending for routine US-guided injection of the knee. Mean fluid depth [in millimetres, (SD)] was significantly greater in the lateral SPP [9.2 (5.1)] than in the medial [6.5 (4.6)] or the midline [5.9 (3.7)] regions with the knee in relaxed full extension (p < 0.001 for comparison of lateral SPP with both midline and medial SPP). Small effusions were more commonly detected in the lateral SPP than elsewhere. In patients with painful knee arthritis, fluid distributes maximally to the lateral SPP in the extended knee. This has implications regarding the anatomical approach to arthrocentesis that clinicians should choose to perform and teach.
Similar content being viewed by others
References
Jackson DW, Evans NA, Thomas BM (2002) Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am 84(9):1522–1527
Esenyel C, Demirhan M, Esenyel M, Sonmez M, Kahraman S, Senel B et al (2007) Comparison of four different intra-articular injection sites in the knee: a cadaver study. Knee Surg Sports Traumatol Arthrosc 15(5):573–577
Neustadt DH (2006) Intra-articular injections for osteoarthritis of the knee. Cleve Clin J Med 73(10):897–911
Roberts WN Jr (2011) Joint aspiration or injection in adults: techniques and indications. In: UptoDate. Furst DE (ed), Waltham, MA
Wittich CM, Ficalora RD, Mason TG, Beckman TJ (2009) Musculoskeletal injection. Mayo Clin Proc 84(9):831–837
Cardone DA, Tallia AF (2003) Diagnostic and therapeutic injection of the hip and knee. Am Fam Phys 67(10):2147–2152
Zuber TJ (2002) Knee joint aspiration and injection. Am Fam Phys 66(8):1497–1501
Cohn BT, Shapiro PS (1993) An effective technique for corticosteroid injection into the knee joint. Orthopaedic Rev 22(12):1341–1342
D’Agostino MA, Conaghan P, Le Bars M, Baron G, Grassi W, Martin-Mola E et al (2005) EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: Prevalence of inflammation in osteoarthritis. Ann Rheum Dis 64(12):1703–1709
Schweitzer ME, Falk A, Berthoty D, Mitchell M, Resnick D (1992) Knee effusion: normal distribution of fluid. Am J Roentgenol 159(2):361–363
Hong BY, Lim SH, Cho YR, Kim HW, Ko YJ, Han SH et al (2010) Detection of knee effusion by ultrasonography. Am J Phys Med Rehab 89(9):715–721
Kolman B, Daffner R, Sciulli R, Soehnlen M (2004) Correlation of joint fluid and internal derangement on knee MRI. Skeletal Radiol 33(2):91–95
Mandl P, Brossard M, Aegerter P, Backhaus M, Bruyn GA, Chary-Valckenaere I et al. (2012) Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion. Arthritis Care Res doi:10.1002/acr.21598
Zayat AS, Freeston JE, Conaghan PG, Hensor EMA, Emery P, Wakefield RJ (2012) Does joint position affect US findings in inflammatory arthritis? Rheumatology. doi:10.1093/rheumatology/ker383
Schumacher HR (2003) Aspiration and injection therapies for joints. Arthritis Rheum–Arthritis Care Res 49(3):413–420
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
The study was undertaken by GH as a research fellow in rheumatology employed through an unrestricted grant from Dudley Group NHS Foundation Trust Research and Development Directive.
Rights and permissions
About this article
Cite this article
Hirsch, G., O’Neill, T., Kitas, G. et al. Distribution of effusion in knee arthritis as measured by high-resolution ultrasound. Clin Rheumatol 31, 1243–1246 (2012). https://doi.org/10.1007/s10067-012-1987-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-012-1987-3