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Arthrocentesis of the Wrist
First locate and feel comfortable identifying two important landmarks:
1) Lister's tubercle is an elevation found in the center of the dorsal aspect of the distal end of the radius
http://www.aafp.org/afp/2004/0415/afp20040415p1941-f2.jpg
2) The extensor pollicis longus (EPL) tendon runs in a grove just radially to Lister's tubercle. Active extension of wrist and thumb aid with identification.
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-pollicis-longus/atlasImage
A) Positioning: Place wrist in ulnar deviation and 20 - 30 degrees of flexion. Apply longitudinal traction to the fingers of the hand.
B) Technique: Insert a small needle (22g) just distal to the tubercle and on the ulnar side of the EPL tendon.
http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79928-80032-1477044tn.jpg
http://www.youtube.com/watch?v=nlPdb_mymw4&feature=related
http://www.youtube.com/watch?v=UVG7fZvZD-s&feature=related
References
Roberts and Hedges Clinical Procedures in Emergency Medicine