Diseases (12)
Diagnostic Testing (12)

Note: Reflex to culture if elevated WBC and no crystals or bacteria are seen.

Note: If joined inflammation and aspiration required.

Note: If arthritis present

Note: If joints are involved.

Note: If arthritis present are involved.

Note: If obtained, the synovial fluid in Neuropathic arthropathy is clear, sterile and lack crystals.

Overview

Synovial fluid analysis is utilized to diagnose the cause of pain, swelling, and fluid collection in the joints. The joints that are most commonly affected are the knee, hip, and shoulder joints. The conditions that affect the synovial fluid can be broken down into five general categories. These disease categories are Non-Inflammatory disease, Inflammatory disease, Infectious disease, Degenerative disease, and Bleeding disorders. Non-inflammatory diseases that are associated with synovial fluid involvement include trauma, sickle cell disease, and CPPD crystal deposition disease (pseudogout). Inflammatory diseases associated with synovial fluid include autoimmune disorders such as systemic lupus erythematosus, psoriasis, and rheumatoid arthritis as well as gout. Infectious arthritis is usually acute bacterial in nature. The most common causative organism in some studies is Neisseria gonnorrhea following by Staphylococcus aureus. Chronic septic arthritis is rare and reported causative organisms include Mycobacterium tuberculosis and Candida albicans. Bleeding disorders that lead to blood in the synovial fluid typically involve individuals with blood clotting disorders such as hemophilia, von Willenbrand’s disease, Glanzmann’s thrombasthenia, and synovial tumors as well as injuries. Degenerative disorders include primarily osteoarthritis which causes erosion of the joint surfaces and accumulation of fibrin.

The most important reason to perform an analysis on synovial fluid is to rule out septic arthritis. Analysis of synovial fluid is rarely needed in pediatric patients, but is used primarily to differentiate between inflammatory and non-inflammatory disease states. Analysis of synovial fluid usually includes multiple studies such as cell count, microscopic analysis, culture, examination for crystals, and other chemical analysis.

Clinical Utility

  • Diagnosis of joint disease such as gout and traumatic arthritis
  • Differential diagnosis of traumatic arthritis from the immune-based and crystal-induced arthritis
  • As an aid in diagnosis of joint disease due to inflammation and infection
  • Aid in diagnosis of joint injury

Interpretation

Abnormal in:

  • Gout (uric acid)
  • Pseudogout (calcium pyrophosphate deposition disease)
  • Rheumatoid arthritis
  • Infectious arthritis (lactate dehydrogenase)
  • Immune-based arthritis
  • Bacterial infection (protein)
  • Joint injury
  • Lower than normal viscocity is associated with inflammation
  • Decreased clarity (cloudy SF) may indicate crystals, WBCs, or microorganisms in the fluid
  • Reddish SF indicates red blood cells in the fluid which can indicate bleeding disorders
  • Decreased glucose is associated with inflammation but compare with serum glucose

Reference Ranges

Parameter Normal Pathological Normal Pathological
Volume, mL (knee) <4 >4 <0.004 L >0.004 L
Viscosity
String test + (high) − (low) — —
Mucin clot Firm Friable — —
Clarity Clear Cloudy — —
Color Straw Red — —
Cell Counts
WBC (/µL) <200 >2000 <0.2 × 109/L >2 × 109/L
Percent of Total / Fraction of Total
PMN <25% >75% <0.25 >0.75
RBC <2% >50% <0.02 >0.50
Chemistry
Total protein 1.2–3.0 g/dL >4.0 g/dL 12–30 g/L >40 g/L
Glucose Serum level − <60 mg/dL — Serum level − 3.4 mmol/L —

Methodology
Visual examination, cell count and differential, polarizing microscopic exam for crystals, Gram stain, AFB smear and culture, Culture and susceptibility testing.

Specimen Collection

Synovial fluid aspirate. EDTA (Lavender) preferred, or Heparin (Green) acceptable.

  • Ideally 15 mL divided into two sodium heparin tubes and one sterile tube without additives.
  • Ambient: 48 hours
  • Refrigerated: 48 hours

Additional Testing

Blood/urine uric acid, Blood glucose, Joint bacterial mycobacterial and fungal cultures as indicated, Blood cultures if systemic infection is suspected, ANA, CBC with differential, ESR, C-reactive protein.

CPT
83872$5.86
84157$4
89051$5.6
89060$7.33

ICD10
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ICD10 CODE AND DESCRIPTIONLCD CODENCD CODE
A01.05 - Typhoid osteomyelitis——
A02.0 - Salmonella enteritis——
A02.24 - Salmonella osteomyelitis——
A03.9 - Shigellosis, unspecified——
A04.5 - Campylobacter enteritis——
A18.02 - Tuberculous arthritis of other joints——
A18.03 - Tuberculosis of other bones——
A30.9 - Leprosy, unspecified——
A41.01 - Sepsis due to Methicillin susceptible Staphylococcus aureus——
A41.02 - Sepsis due to Methicillin resistant Staphylococcus aureus——
A41.89 - Other specified sepsis——
A41.9 - Sepsis, unspecified organism——
A49.1 - Streptococcal infection, unspecified site——
A52.16 - Charcot's arthropathy (tabetic)——
A54.42 - Gonococcal arthritis——
A54.43 - Gonococcal osteomyelitis——
A54.9 - Gonococcal infection, unspecified——
A56.00 - Chlamydial infection of lower genitourinary tract, unspecified——
A56.19 - Other chlamydial genitourinary infection——
A68 - Relapsing fevers——
A69.23 - Arthritis due to Lyme disease——
A78 - Q fever——
B95 - Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere——
B95.0 - Streptococcus, group A, as the cause of diseases classified elsewhere——
B95.1 - Streptococcus, group B, as the cause of diseases classified elsewhere——
B95.61 - Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere——
B95.62 - Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere——
B95.7 - Other staphylococcus as the cause of diseases classified elsewhere——
B95.8 - Unspecified staphylococcus as the cause of diseases classified elsewhere——
D57.1 - Sickle-cell disease without crisis——
D64 - Other anemias——
D64.9 - Anemia, unspecified——
D84.9 - Immunodeficiency, unspecified——
E08.610 - Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy——
E09.610 - Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy——
E10.42 - Type 1 diabetes mellitus with diabetic polyneuropathy——
E10.610 - Type 1 diabetes mellitus with diabetic neuropathic arthropathy——
E11.40 - Type 2 diabetes mellitus with diabetic neuropathy, unspecified——
E11.42 - Type 2 diabetes mellitus with diabetic polyneuropathy——
E11.51 - Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene——
E11.610 - Type 2 diabetes mellitus with diabetic neuropathic arthropathy——
E11.9 - Type 2 diabetes mellitus without complications——
E13.610 - Other specified diabetes mellitus with diabetic neuropathic arthropathy——
E66.9 - Obesity, unspecified——
E79 - Disorders of purine and pyrimidine metabolism——
E79.0 - Hyperuricemia without signs of inflammatory arthritis and tophaceous disease——
E79.9 - Disorder of purine and pyrimidine metabolism, unspecified——
E85 - Amyloidosis——
E85.9 - Amyloidosis, unspecified——
F11 - Opioid related disorders——

Additional ICD10
  • AK - Alaska
  • AL - Alabama
  • AR - Arkansas
  • AS - American Samoa
  • AZ - Arizona
  • CA - California - Entire State
  • CO - Colorado
  • CT - Connecticut
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  • VA - Virginia
  • VI - Virgin Islands
  • VT - Vermont
  • WA - Washington
  • WI - Wisconsin
  • WV - West Virginia
  • WY - Wyoming
  • CNMI - Northern Mariana Islands
  • EM - Missouri - Northeastern & Southern
  • WM - Missouri - Northwestern
  • DN - New York - Downstate
  • QN - New York - Queens
  • UN - New York - Upstate
  • NF - California - Northern
  • SF - California - Southern
Showing results for all states.
Filter:
ICD10 CODE AND DESCRIPTIONLCD CODENCD CODE
A68.0 - Louse-borne relapsing fever——
A68.1 - Tick-borne relapsing fever——
A68.9 - Relapsing fever, unspecified——
B95.0 - Streptococcus, group A, as the cause of diseases classified elsewhere——
B95.1 - Streptococcus, group B, as the cause of diseases classified elsewhere——
B95.2 - Enterococcus as the cause of diseases classified elsewhere——
B95.3 - Streptococcus pneumoniae as the cause of diseases classified elsewhere——
B95.4 - Other streptococcus as the cause of diseases classified elsewhere——
B95.5 - Unspecified streptococcus as the cause of diseases classified elsewhere——
B95.6 - Staphylococcus aureus as the cause of diseases classified elsewhere——
B95.61 - Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere——
B95.62 - Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere——
B95.7 - Other staphylococcus as the cause of diseases classified elsewhere——
B95.8 - Unspecified staphylococcus as the cause of diseases classified elsewhere——
D64.0 - Hereditary sideroblastic anemia——
D64.1 - Secondary sideroblastic anemia due to disease——
D64.2 - Secondary sideroblastic anemia due to drugs and toxins——
D64.3 - Other sideroblastic anemias——
D64.4 - Congenital dyserythropoietic anemia——
D64.8 - Other specified anemias——
D64.81 - Anemia due to antineoplastic chemotherapy——
D64.89 - Other specified anemias——
D64.9 - Anemia, unspecified——
E79.0 - Hyperuricemia without signs of inflammatory arthritis and tophaceous disease——
E79.1 - Lesch-Nyhan syndrome——
E79.2 - Myoadenylate deaminase deficiency——
E79.8 - Other disorders of purine and pyrimidine metabolism——
E79.9 - Disorder of purine and pyrimidine metabolism, unspecified——
E85.0 - Non-neuropathic heredofamilial amyloidosis——
E85.1 - Neuropathic heredofamilial amyloidosis——
E85.2 - Heredofamilial amyloidosis, unspecified——
E85.3 - Secondary systemic amyloidosis——
E85.4 - Organ-limited amyloidosis——
E85.8 - Other amyloidosis——
E85.81 - Light chain (AL) amyloidosis——
E85.82 - Wild-type transthyretin-related (ATTR) amyloidosis——
E85.89 - Other amyloidosis——
E85.9 - Amyloidosis, unspecified——
F11.1 - Opioid abuse——
F11.10 - Opioid abuse, uncomplicated——
F11.11 - Opioid abuse, in remission——
F11.12 - Opioid abuse with intoxication——
F11.120 - Opioid abuse with intoxication, uncomplicated——
F11.121 - Opioid abuse with intoxication delirium——
F11.122 - Opioid abuse with intoxication with perceptual disturbance——
F11.129 - Opioid abuse with intoxication, unspecified——
F11.13 - Opioid abuse with withdrawal——
F11.14 - Opioid abuse with opioid-induced mood disorder——
F11.15 - Opioid abuse with opioid-induced psychotic disorder——
F11.150 - Opioid abuse with opioid-induced psychotic disorder with delusions——

References

  • Best Pract Res Clin Rheumatol. 2009 Apr;23(2):161-92. [PMID: 19393565]
  • J Emerg Med. 2006 Apr;30(3):331-9. [PMID: 16677989]
  • Ann Rheum Dis. 2002 Jun;61(6):493-8. [PMID: 12006320]
  • Best Pract Res Clin Rheumatol. 2005 Jun;19(3):371-86. [PMID: 15939364]
  • Alan Wu. Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders; 4 edition (June 13, 2006). ISBN-10: 0721679757