Ankle Arthrocentesis

imagesDiagnostic


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


      imagesSeptic arthritis


      imagesCrystal arthropathy


      imagesHemarthrosis


      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


imagesTherapeutic


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


   imagesInstill medication for treatment and pain relief


CONTRAINDICATIONS



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


RISKS/CONSENT ISSUES



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


   imagesAnalgesia


   imagesAspiration


   imagesFluid analysis


LANDMARKS



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



images


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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