Ultrasound vs. Landmark-Guided Technique for Medium-Sized Joint Aspiration

Historically, physicians have used anatomic landmarks to guide arthrocentesis. However, we now recognize that the physical exam has limited diagnostic accuracy for detecting joint effusions. Furthermore, patient body habitus and joint size might limit the accuracy of landmarks for arthrocentesis. In this single-center, U.S. randomized trial, 44 patients with suspected effusion in a medium-sized joint (i.e., wrist, ankle, or elbow) underwent arthrocentesis either with initial ultrasound guidance or with landmark guidance followed by ultrasound guidance if initial landmark guidance was unsuccessful. All procedures were performed by emergency medicine residents who had completed a 4-hour ultrasound procedural course and a 4-week emergency ultr…