Coagulopathy

The coagulation panel should be checked prior to the procedure if there is clinical suspicion of a coagulation abnormality (3). As in all procedures, the risks and benefits should be reviewed before beginning. Coagulopathy should be treated if reversal of coagulopathy is feasible in the context of the patient's other underlying conditions, and if time permits. Under these circumstances, a smaller needle may be used for joint aspiration to minimize bleeding complications

Local or systemic infection

Introducing a needle through an overlying skin infection theoretically could seed bacteria into the joint. Therefore, if possible, one should avoid areas of the skin suspected of having cellulitis. However, it should be noted that the majority of septic joints are seeded secondary to hematogenous spread rather than by surface penetration (1).

INTRA-ARTICULAR INJECTION OF DRUGS

For intra-articular injections of drugs such as steroids, the absolute and relative contraindications are the following:

Absolute

• Known or suspected septic joint.

Relative

• Intraarticular fracture
• Joint instability
• Multiple previous steroid injections - The maximum number of acceptable injections per year is three because of the concern for potential cartilage damage and steroid-induced arthropathy with frequent injections (1)
• Juxta-articular osteopenia
• Inability of the patient to rest the joint after injection (3).