musculoskeletal and connective tissue disorders
How To Do Ankle Arthrocentesis
Step by Step Description of Ankle Arthrocentesis
Palpate the anterior medial aspect of the ankle joint to identify the medial malleolus and the tibialis anterior tendon. The insertion site is the hollow between this tendon and the anterior edge of the medial malleolus. Ask the patient to dorsiflex the ankle, making the tendon easy to see and palpate. If desired, mark the insertion site with a skin-marking pen or preferably an indentation (before cleansing the skin). 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-gauge needle. Then inject more anesthetic along the anticipated trajectory of the arthrocentesis needle (about 2 to 3 cm), but do not enter the joint space. Allow 2 minutes for the anesthetic effect to occur. Aspirate the joint using a 20-gauge needle on a 10-mL syringe. Insert the needle perpendicular to the skin, midway between the medial malleolus and the tibialis anterior tendon. Direct the needle posteriorly into the joint space, and pull back gently 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 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. Inspect the fluid for blood and fat. Transfer synovial fluid to tubes and other transport media for Synovial fluid examination . 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. 