musculoskeletal and connective tissue disorders
How To Do Metatarsophalangeal Joint Arthrocentesis
Step by Step Description of MTP Joint Arthrocentesis
Have the patient dorsiflex the great toe. Then, in this position, palpate the dorsal aspect of the metatarsophalangeal (MTP) joint and the prominent dorsiflexed extensor tendon. Rest the foot on an underpad. Prepare the area with a skin-cleansing agent, such aschlorhexidineor povidone iodine, then use an alcohol wipe to remove the agent. Place a wheal of local anesthetic over the needle entry site using a 25- to 30-gauge needle. Have an assistant manually plantarflex (about 20°) and apply axial traction to the toe to facilitate entry of the aspirating needle into the joint space. Aspirate the joint using a 22-gauge needle. Enter the skin perpendicularly, at the level of the joint line, just medial or lateral to the extensor tendon. Direct the needle toward the center of the joint space. Gently pull back on the plunger as you advance. Synovial fluid will enter the syringe when the joint is entered. If the needle hits bone, retract almost to skin surface and then redirect the needle at a different angle. Drain all fluid from the joint. If intra-articular medications (eg, anesthetic, corticosteroid) are to be given, hold the hub of the needle motionless (using a hemostat if available) while removing the synovial fluid-containing syringe and replace it with the medication-containing syringe. If the needle has remained in place in the joint space, there will be no resistance to medication injection. After injecting a corticosteroid, move the joint through full range of motion to distribute the medication throughout the joint. Transfer synovial fluid to tubes and other transport media for Synovial fluid examination . Inspect the fluid for blood and fat. Apply an adhesive bandage or sterile dressing. © Elsevier Inc. All Rights Reserved. This video is for personal informational use. Users are prohibited from copying, reproducing, licensing, subscribing, selling, leasing or distributing this video. 