UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
SEAT NUMBER: 29
NAME Jinela Mary
YEAR AND SECTION: 2-EMT
DATE SUBMITTED: May 2, 2019
SUBJECT: SYNOVIAL FLUID
TOPIC: SYNOVIAL FLUID ANALYSIS
TOPIC OBJECTIVES
A. Give an overview of synovial fluid analysis
B. How the synovial fluid is collected
C. Synovial fluid analysis diagnostic tests (physical, chemical, microscopic, and infectious
disease tests)
D. Risks of synovial fluid analysis
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
SYNOVIAL FLUID ANALYSIS
I.
OVERVIEW
Synovial fluid analysis, also known as synovial joint analysis, consists of a group of tests
that detect synovial fluid changes to help diagnose the cause of joint pain and to rule out infections
and some serious conditions that may require immediate treatment. It may also be used to monitor
a person with known joint conditions such as, arthritis, gout, infections, and bleeding disorders to
see if the treatment is working. When a person has painful or swollen joints, a doctor can extract
and analyze a sample of their synovial fluid to help determine the cause of these symptoms in a
process called arthrocentesis.
II.
SPECIMEN COLLECTION
Arthrocentesis is generally a simple technique to obtain important diagnostic information
that is not available from history and physical examination. It can be performed at the bedside
with few complications as long as sterile technique is observed. Most joints are readily accessible
to needle aspiration. The physician will perform an arthrocentesis and aspirate the effected joint
after finding positive results with a “bulge test”. An appropriate gauge needle is attached to a
syringe and the entry site is cleansed.
A two-step process is employed for arthrocentesis in which the first puncture is made
through the skin followed by a second thrust into the synovial capsule. Removing as much SF as
possible will help relieve joint pain and may help control infection. After fluid is aspirated and the
needle withdrawn from the joint, the needle is removed and an end cap placed on the tip of the
syringe. The syringe is properly labeled and sent to the laboratory for testing.
Synovial fluid is examined “fresh” requiring careful handling in the laboratory and a need
to minimize cell and crystal loss, which can dramatically adversely affect diagnosis, during
transport to the laboratory. Storage at 4°C is well tolerated by the synovial fluid and prolongs
transport times, but even so, adequate diagnosis that even cooled samples must reach the
laboratory within 48 hours of aspiration.
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
III.
DIAGNOSTIC TESTS
There are many ways to analyze synovial fluid, including physical and visual examinations,
looking at the joint fluid under a microscope, assessing the fluid’s chemical make-up, and testing
the fluid for bacteria, fungi, or other abnormal contents. A doctor will decide what types of analyses
should be performed based on the patient’s symptoms and health history.
Tests can be grouped according to:
A. Physical and Visual Examination of Synovial Fluid
Changes in physical characteristics provides clues to the disease present. An
individual's joint may be affected by more than one of these physical changes at a
time.
Table 1. Physical characteristic of synovial fluid and its indication.
Physical
Variations in Physical
Characteristic
Characteristic
Indication
Volume
Greater quantity of fluid
inflammation
Viscosity
Less viscous fluid
inflammation
Color and clarity
Cloudy synovial fluid
increased number of
red blood cells
Reddish synovial fluid
presence of blood
Yellow to greenish yellow
inflammatory fluids
B. Chemical Analysis of Synovial Fluid
Table 2. Chemical content of synovial fluid and its indication.
Chemical Content
Indication
Uric acid
higher than normal for people with gout
Glucose levels
lower than normal may indicate infection while slightly low
glucose levels are also sometimes seen in rheumatoid
arthritis.
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
Lactate
might be at elevated levels in people who have rheumatoid
dehydrogenase
arthritis, infectious arthritis, or gout
(LDH)
Protein levels
higher than normal may indicate an infection
C. Microscopic Analysis of Synovial Fluid
Normal synovial fluid has small numbers of white blood cells (WBCs) and red blood
cells (RBCs) but no microbes or crystals present. Laboratories may examine drops of
the synovial fluid and/or use a special centrifuge (cytocentrifuge) to concentrate the
fluid's cells at the bottom of a test tube. Samples are placed on a slide, treated with
special stain, and an evaluation of the different kinds of cells present is performed.
Table 3. Possible unusual traits of synovial fluid under microscope and its
indication.
Synovial fluid under
Unusual traits
Indication
Microscope
Crystals
uric acid crystals
calcium
gout
pyrophosphate pseudogout
crystals
White blood cell count
higher than normal
infectious arthritis, gout, or
rheumatoid arthritis
Red blood cell count
higher than normal
after a traumatic injury,
osteoarthritis,
and
hemophilia
Microorganisms
bacteria
Infection and typically can
be verified with a culture
study
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
D. Infectious disease tests
In addition to chemistry tests, other tests may be performed to look for microbes if
infection is suspected.
Table 4. Infectious disease tests of synovial fluid and its description.
Infectious disease tests
Gram stain
Description
allows
for
the
direct
observation
of bacteria or fungi under a microscope
Culture
Determines what type of microbes are present. If
there are no microbes present, it does not rule
out an infection; they may be present in small
numbers or their growth may be inhibited
because of prior antibiotic therapy.
Susceptibility testing
If bacteria are present, susceptibility testing
against certain antibiotics can be performed to
guide antimicrobial therapy.
AFB testing
less commonly ordered
Overall, lab tests are not infallible and doctors do not use lab test results alone to make a
diagnosis. Rather, these results are used in conjunction with information gathered from a physical
examination, patient interview, and other sources such as X-rays. Results are usually available
to patients within 1 to 3 days. In an emergency, lab tests might be expedited and results will be
available sooner.
IV.
RISKS
Synovial fluid analysis is a very safe procedure when a doctor performs it in sterile
conditions. People may experience some bleeding or soreness around the site of injection after
the procedure, but this should not last long. If the needle were not sterile, this could cause an
infection. However, this scenario is unlikely to occur.
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
REFERENCES
A. Books
1. Brunzel, N. A. (2018). Fundamentals of urine & body fluid analysis. St. Louis (Mo.):
Elsevier.
2. Paget, S. A., & Gibofsky, A. (2006). Manual of rheumatology and outpatient
orthopedic disorders: Diagnosis and therapy. Retrieved April 30, 2019.
3. Graff, L., Shanahan, K., & Mundt, L. A. (n.d.). Graff's textbook of urinalysis and
body fluids (3rd ed.). Retrieved April 30, 2019.
B. Journal Articles
1. Brannan, S. R., & Jerrard, D. A. (2006). Synovial fluid analysis. The Journal of
Emergency Medicine, 30(3), 331-339. doi:10.1016/j.jemermed.2005.05.029
2. Synovial fluid analysis in the diagnosis of joint disease. (2017, May 24). Retrieved
April
30,
2019,
from
https://www.sciencedirect.com/science/article/pii/S1756231717300531
C. Internet Sources
1. Kandola, A. (n.d.). Synovial (joint) fluid analysis: Procedure and results. Retrieved
April 30, 2019, from https://www.medicalnewstoday.com/articles/323474.php
2. Synovial (Joint) Fluid Analysis: Purpose, Procedure, Results. (n.d.). Retrieved
April 30, 2019, from https://www.webmd.com/arthritis/synovial-joint-fluid-analysis
3. Synovial fluid analysis: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved April
30, 2019, from https://medlineplus.gov/ency/article/003629.htm
4. Synovial
Fluid
Analysis.
(n.d.).
Retrieved
April
30,
2019,
from
https://labtestsonline.org/tests/synovial-fluid-analysis#no-back
5. Cole, J. D. (n.d.). Diagnosis through Synovial Fluid Analysis. Retrieved April 30,
2019, from https://www.arthritis-health.com/treatment/joint-aspiration/diagnosisthrough-synovial-fluid-analysis
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
SYNOVIAL FLUID ANALYSIS
ASSESSMENT AND EVALUATION
TYPE OF EXAM
Morse Type: True or False
NUMBER OF ITEMS
2
INSTRUCTION: The following items are followed in performing synovial fluid analysis in the
laboratory.
A if the first statement is True and the second statement is False.
B if the first statement is False and the second statement is True.
C if both of the statements are True.
D if both of the statements are False.
_____A____ 1. Changes in physical characteristics provides clues to the disease present. A less
viscous synovial fluid indicates increase in red blood cell production.
_____C____ 2. Synovial fluid analysis is also known as synovial joint analysis. Removing as
much SF as possible will help relieve joint pain and may help control infection
TYPE OF EXAM
Multiple Choice Items
NUMBER OF ITEMS
8
INSTUCTION: Choose the best answer by encircling the correct letter of your choice.
1. Allows for the direct observation of bacteria or fungi under a microscope
a. Gram Stain
b. Culture
c. AFB testing
d. Susceptibility testing
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
2. A technique to obtain important diagnostic information that is not available from history and
physical examination
a. SDD
b. Arthrocentesis
c. Synovial fluid extraction
d. Bulge Test
3. Higher than normal for people with gout
a. Glucose levels
b. Uric acid
c. Cysteine
d. Cystine
4. Cooled samples must reach the laboratory within ____ of aspiration.
a. 32 hours
b. 24 hours
c. 3 days
d. 48 hours
5. Higher than normal in patients with hemophilia
a. RBC count
b. WBC count
c. Albumin
d. Yellow crystals
6. A cloudy synovial fluid indicates
a. decreased number of red blood cells
b. increased number of red blood cells
c. increased number of white blood cells
d. decreased number of white blood cells
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UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education
TEACHING DEMONSTRATION
7. Higher than normal protein levels may indicate
a. pseudogout
b. infection
c. inflammation
d. gout
8. Might be at elevated levels in people who have rheumatoid arthritis, infectious arthritis, or gout
a. gout
b. pseudogout
c. Lactate dehydrogenase (LDH)
d. Glucose levels
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