UMEM Educational Pearls

Category: Orthopedics

Title: Evaluation of Potential Intra-Articular Joint Lacerations

Keywords: Methylene Blue, Intra-articular, Joint (PubMed Search)

Posted: 11/21/2010 by Michael Bond, MD
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Evaluation of Potential Intra-Articular Joint Lacerations

Skin and soft tissue injuries in proximity to a joint often prompt concern of whether the injury violated the joint space.  Joint Space involvement is important to exclude as it can lead to septic joints and long term disability.

One easy way to determine if the joint capsule has been violated is to inject methylene blue into the joint and watch to see if any of the methylene blue extravasates through the soft tissue.

Indications for a methylene blue injection include:

  1. Periarticular fracture
  2. Visible joint capsule
  3. Proximity to a joint

There are no absolute contraindications.  Though clearly the procedure does not need to be done when the injury  highly suggests an open joint injury and the patient will require operative debridement and exploration.

To watch a video of a injection head to eMedicine by clicking


Shlamovitz, Gil. Injection, Intra-Articular Methylene Blue. eMedince, Accessed November 2010.