Abstract
Female 22 years old, come to RSMP with pain and swollen in the right knee after fall down from stairs 2 days ago. In Physical Examination found bruising around the knee with no sign of crepitation nor abnormality during ligament test. Patient than given initial treatment (analgesic and antifibrinolytic) for 1 week and X-ray examination of knee. One week later patient come with decreased but persisted pain and swollen knee. X-ray Examination suggests joint effusion. The Patient than admitted for arthrocentesis followed by Intra-articular normal saline and lidocaine injection.
Bleeding into a joint is referred to as hemarthrosis and is an important cause of monoarticular joint pain and swelling. Its can be suspected based on patient history, physical exam, and multiple imaging modalities, however the best way to diagnose hemarthrosis is with arthrocentesis with synovial fluid analysis. Traumatic injury is the most common cause and the knee is a frequent site of hemarthrosis. Initial treatment of any acute hemarthrosis includes immobilization, ice, and compression. Analgesia for pain control may be required in the acute period. Arthrocentesis with aspiration from a joint can be both diagnostic and therapeutic by reducing pressure from the effusion.
Intra-articular normal saline (IA-NS) injections have been utilized as a placebo in a number of researches pertaining to the management of joints problem such as knee osteoarthritis (OA). It is believed that these IA-NS injections may have a therapeutic effect that has not been quantified in the literature. Lidocaine have some mild anti-inflammatory effect during its relatively short halflife of 1.5 hours. The prompt effect of the local anesthetic providing temporary relief of symptoms can help confirm proper placement of the injection and support that the site injected was the source of the pain.