Пункция плечевого сустава представляет собой a surgical procedure, during which the doctor enters the needle into the joint bag. Such a procedure is carried out for diagnostic purposes or for medical reasons. The purpose of this procedure is to reduce the amount of synovial fluid in the joint.
Surgeons subdivide punctures into two types:
When performing puncture of the shoulder jointit is necessary to take into account the characteristic features of his anatomy. The synovial membrane is a membrane, which in its structure and origin differs from membranes of serous (such as the membrane of the pleura, peritoneum, pericardium). The main difference is that its inner side, facing the surface cavity, does not contain epithelial cover and endothelial lining. The thickness of the membrane is not the same. In addition, it has increased sensitivity to thermal, traumatic, infectious and chemical influences.
Due to the increased sensitivity of the synovialshell to a variety of infections requires strict observance of asepticity before the procedure of puncture, as well as before opening the articular cavity. In addition, its mandatory sealing is necessary. The joint cavity contains a small amount of synovial fluid, about four milliliters. Synovial fluid is sterile, has a yellowish-straw color and at the same time is absolutely transparent. It is characterized by high viscosity, it contains phagocytes and leukocytes, but its bactericidal properties are very small. Due to the fact that synovial fluid is saturated with high specific gravity mucopolysaccharides, it accumulates in the joint, and does not diffuse from its cavity.
Technique of puncture of the shoulder joint will be discussed below.
Get joint fluid and not causepathological process is very difficult because of its small amount, negative pressure and increased viscosity. Healthy joints have negative pressure:
The presence of negative pressure causes osmosis of fluid from the subchondral and synovial plates, from where the cartilage tissue of the joint is nourished.
Puncture of the shoulder joint in healthy people is performed in rare cases.
The main functions performed by synovial fluid include:
If there is an inflammatory process in the joint,then in the synovial fluid increases the protein content. This is due to increased vascular permeability. The fluid becomes turbid, it increases the content of neutrophilic leukocytes as a result of acute traumatic synovitis.
For this, a diagnostic puncture of the shoulder joint is prescribed.
For these purposes, a puncture of the shoulder and knee joints can be performed.
Due to the extreme sensitivity of synovial fluid to infections, during the puncture of the joint it is necessary to strictly follow all the rules of antisepsis and asepsis.
Before puncture, puncture siteshould be thoroughly disinfected. It is advisable to use seventy percent alcohol. After the skin at the puncture site has been smeared with a 5% iodine solution, its remnants should be removed by wiping it twice with alcohol. The removal of iodine residues, especially with abundant lubrication, is required because iodine together with the needle can penetrate the articular cavity, and this causes irritation of the synovial membrane and a strong burn reaction. In addition, iodine can absorb X-rays, and this can affect the reliability of the image - it can display additional shadows distorting the image.
Use local infiltration anesthesia.
Needle length for puncture 5-6 centimeters.If the introduction of oxygen is carried out, then the needle should be used thin, up to one millimeter in diameter. Otherwise, the gas will be able to penetrate the soft tissues surrounding the joint. This, in turn, will trigger subcutaneous, periarticular, or muscular emphysema.
The skin at the puncture point of the shoulder joint is necessarymove aside. This allows you to bend the wound canal left by the needle, and after the procedure, the skin is returned into place. This technique allows you to avoid the penetration of infection from the surface of the body into the articular cavity.
The needle should be advanced very slowly, tryingdetermine when the end of it will pass into the articular bag. If there is blood in the articular cavity, then a staining of the novocaine solution in the syringe will occur, and if there is pus, then the solution will become cloudy.
There are different opinions regarding the depth from which it is necessary to carry out the puncture. Some literature says that the needle should penetrate a maximum of one centimeter, and the other - by 2-3 centimeters.
Liquid at a puncture needs to be sucked awaya syringe with a volume of 10 to 20 grams. If required - injected drugs. After removing the needle, the displaced skin is released, thereby bending the wound canal, then the puncture site is treated with alcohol and a sterile dressing is applied.
Puncture of this joint should be performed laterally,front or rear. If the procedure is performed in front, then the patient should be put on his back. After that, the surgeon should grope the coracoid process of the scapula, which is three centimeters lower than the distal end of the clavicle. The needle should be inserted under it and lead between the head of the bone of the shoulder and its process from front to back. The needle is inserted at a depth of 4 centimeters.
Если пункция плечевого сустава проводится surgeon side, then the patient must be laid on the opposite side, and his hand is placed strictly along the body. The width of the finger slightly below the large tubercle is the head of the humerus, its head. The needle should be injected under that part of the acromion process, which is the most prominent, and then propel it through the deltoid muscle in the frontal plane.
During the procedure of puncture behind the patientrequired to lay on the stomach. After that, the surgeon gropes the deltoid muscle and its lower edge. In this place there is a fossa, located slightly lower than the posterior edge of the acromion process. In this place it is necessary to inject a needle and enter it to a depth of 5 centimeters in the direction of the coracoid process of the scapula.
