Joint effusion

A joint effusion is the presence of increased intra-articular fluid.[1] It may affect any joint. Commonly it involves the knee.

Joint effusion
A traumatic right knee effusion. Note the swelling lateral to the kneecap as marked by the arrow.
SpecialtyOrthopedics, rheumatology

Diagnostic approach

The approach to diagnosis depends on the joint involved. While aspiration of the joint is considered the gold standard of treatment, this can be difficult for joints such as the hip. Ultrasound may be used both to verify the existence of an effusion and to guide aspiration.[2]

  • Skyline view of the patella demonstrating a large joint effusion as marked by the arrow.
  • A schematic drawing showing the sail sign which represents an effusion.

Differential diagnosis
Synovial fluid examination[3][4]
TypeWBC per mm3% neutrophilsViscosityAppearance
Normal<2000HighTransparent
Osteoarthritis<5000<25HighClear yellow
Trauma<10,000<50VariableBloody
Inflammatory2,000-50,00050-80LowCloudy yellow
Septic arthritis>50,000>75LowCloudy yellow
Gonorrhea~10,00060LowCloudy yellow
Tuberculosis~20,00070LowCloudy yellow
Inflammatory = gout, rheumatoid arthritis, rheumatic fever

There are many causes of joint effusion. It may result from trauma, inflammation, hematologic conditions, or infections.[1]

Septic arthritis

Septic arthritis is the purulent invasion of a joint by an infectious agent[5] with a resultant large effusion due to inflammation.[6]

Gout

Gout is usually present with recurrent attacks of acute inflammatory arthritis (red, tender, hot, swollen joint). It is caused by elevated levels of uric acid in the blood that crystallizes and deposits in joints, tendons, and surrounding tissues. Gout affects 1% of individuals in Western populations at some point in their lives.[7]

Trauma

Trauma from ligamentous, osseous or meniscal injuries can result in an effusion.[8] These are often hemarthrosis or bloody effusions.

Treatment

Rest

See also

References
  1. Mathison DJ, Teach SJ (November 2009). "Approach to knee effusions". Pediatr Emerg Care. 25 (11): 773–86, quiz 787–8. doi:10.1097/PEC.0b013e3181bec987. PMID 19915432.
  2. Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. p. Chapter 53. ISBN 978-0-323-05472-0.
  3. Flynn, John A.; Choi, Michael J.; Wooster, L. Dwight (2013). Oxford American Handbook of Clinical Medicine. OUP USA. p. 400. ISBN 978-0-19-991494-4.
  4. Seidman, Aaron J.; Limaiem, Faten (2019), "Synovial Fluid Analysis", StatPearls, StatPearls Publishing, PMID 30725799, retrieved 2019-12-19
  5. "septic arthritis" at Dorland's Medical Dictionary
  6. Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. p. Chapter 134. ISBN 978-0-323-05472-0.
  7. Chen LX, Schumacher HR (October 2008). "Gout: an evidence-based review". J Clin Rheumatol. 14 (5 Suppl): S55–62. doi:10.1097/RHU.0b013e3181896921. PMID 18830092.
  8. Johnson MW (April 2000). "Acute knee effusions: a systematic approach to diagnosis". Am Fam Physician. 61 (8): 2391–400. PMID 10794580.
Classification
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