Before a therapeutic intra-articular injection, you should always?

• A. Drain joint fluid completely
• B. Administer prophylactic antibiotics
• C. Obtain imaging confirmation
• D. Coagulation profile

Answer: (A)

Drain joint fluid completely before giving the therapeutic intra-articular injection. Removing the effusion helps the injected medication stay in the joint space and disperse where it’s needed, which can improve pain relief and the therapeutic effect. It also provides synovial fluid for analysis, so you can check for infection or crystals and rule out septic arthritis before injecting, since injecting into an infected joint would worsen the condition. Prophylactic antibiotics aren’t routinely used for a single joint injection because sterile technique and proper preparation already minimize infection risk, and routine antibiotic prophylaxis isn’t indicated unless there’s a specific infection risk. Imaging confirmation isn’t necessary for most injections and is reserved for uncertain anatomy or when ultrasound guidance is planned. A coagulation profile isn’t universally required; assess bleeding risk based on the patient’s history and medications, rather than applying it to every case.