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This handbook purports to be "practical," but for whom? For the busy practitioner who takes time to read the Archives but has had scant training and minimal interest in examining joints, though he carefully auscultates, percusses, and palpates every other protrusion, organ, and cavity due to his general training?
The opening premise of this handbook is that synovial fluid analysis is equally important as urinalysis in the workup of a patient with joint problems. It is true that properly obtained synovial fluid provides much information; it can confirm the specific diagnoses of crystal-induced arthritis and septic arthritis and can determine whether the joint disease is inflammatory or noninflammatory. Ah, but to obtain that fluid correctly! Synovial analysis is an invasive procedure. To obtain fluid from the small, red, painful joint of podagra, the deep, more hidden joints of the shoulder or hip, or even the bulging but tiny proximal interphalangeal
Roth SH. A Practical Handbook of Joint Fluid Analysis,. Arch Intern Med. 1985;145(7):1178. doi:10.1001/archinte.1985.00360070048005