Ankle Arthrocentesis

Diagnostic

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

Septic arthritis

Crystal arthropathy

Hemarthrosis

Inflammatory process

Diagnose occult fracture or ligamentous injury

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

Therapeutic

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

Instill medication for treatment and pain relief

CONTRAINDICATIONS

Absolute Contraindications

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

Relative Contraindications

Bleeding diatheses or anticoagulant therapy

Known bacteremia

Prosthetic joint

RISKS/CONSENT ISSUES

Potential for introducing infection (sterile technique must be utilized)

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

Needle puncture can cause localized bleeding

Reaccumulation of fluid may occur

Risk of injuring articular cartilage with needle tip

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

General Basic Steps

Position patient

Analgesia

Aspiration

Fluid analysis

LANDMARKS

Two approaches are available (FIGURE 57.1):

Medial approach (most common):

Identify 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.

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

Lateral 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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