[A history of joint puncture and injection]

Up until the middle of the 20th century joint puncture was considered a dangerous surgical intervention performed primarily to drain pus. The differential diagnostic significance of synovial analysis only became clear in the second half of the 20th century. Thus it became possible to reliably distinguish between inflammatory and non-inflammatory diseases, and establish whether arthritides are bacterial or crystal-induced. Attempts to inject disinfecting or anti-inflammatory solutions into the joint go back to the end of the 19th century. In the mid 20th century, cortisone became the panacea of intraarticular therapy. After surgeons at the end of the 19th century succeeded in surgically removing the inflamed synovium, internal medicine specialists attempted to destroy the synovial membrane by injecting it with various chemicals around the mid 20th century; however, hardly any of these substances survived. Only with "internal radiation" by injecting radionuclides was a breakthrough seen in the middle of the 20th century. Since then radiosynoviorthesis and synovialectomy have become standard methods in the treatment of chronic inflammatory joint disease.