Ankle Arthrocentesis


   imagesEvacuate abnormal collections of fluid from the joint space for synovial fluid analysis of the following suspected conditions:

      imagesSeptic arthritis

      imagesCrystal arthropathy


      imagesInflammatory process

   imagesDiagnose occult fracture or ligamentous injury

   imagesInject sterile saline to test for joint capsule integrity when overlying laceration potentially extends into joint space


   imagesDrain effusion to decrease/relieve pressure in the joint to provide pain relief

   imagesInstill medication for treatment and pain relief


imagesAbsolute Contraindications

   imagesAbscess/cellulitis in the tissues overlying the site to be punctured (often infectious arthritis can mimic an overlying soft-tissue infection)

imagesRelative Contraindications

   imagesBleeding diatheses or anticoagulant therapy

   imagesKnown bacteremia

   imagesProsthetic joint


imagesPotential for introducing infection (sterile technique must be utilized)

imagesProcedure can cause pain and discomfort (local anesthesia will be given)

imagesNeedle puncture can cause localized bleeding

imagesReaccumulation of fluid may occur

imagesRisk of injuring articular cartilage with needle tip

imagesPotential for tendon and nerve damage if a medication is incorrectly instilled

imagesGeneral Basic Steps

   imagesPosition patient



   imagesFluid analysis


imagesTwo approaches are available (FIGURE 57.1):

   imagesMedial approach (most common):

      imagesIdentify the malleolar sulcus which allows a portal to the tibiotalar joint space. It is a small depression that is bordered by the medial malleolus medially and the anterior tibial tendon laterally.

      imagesBe wary of the saphenous vein and nerve, which lie laterally to medial malleolus

   imagesLateral approach: The subtalar joint space lies approximately ½ inch proximal and medial to the distal tip of the lateral malleolus


FIGURE 57.1 Arthrocentesis of the ankle. (Modified from Simon RR, Brenner BE. Emergency Techniques and Procedures. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:246, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Ankle Arthrocentesis
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