Figure 2 One handed use of the reciprocating syringe for aspiration of a large shoulder effusion. This photograph shows the reciprocating syringe being used in a one handed fashion for aspiration and drainage of a shoulder effusion. The larger plunger is depressed with the thumb for injection and the smaller plunger is depressed with the thumb for aspiration. As shown here the smaller plunger is depressed for continuous aspiration. The free hand is used to feel, steady, and apply pressure to the effusion or operate an ultrasound transducer.