Ankle Arthrocentesis

Summary

This video guide explains the process of performing a landmark-guided ankle arthrocentesis, focusing on the anteromedial and anterolateral approaches. It covers key anatomical landmarks, needle insertion techniques, and troubleshooting when synovial fluid is not easily obtained. The procedure includes numbing options, such as using ice or Lidocaine, and emphasizes the importance of correct needle placement and aspiration for successful fluid collection. The video aims to educate healthcare professionals on safely and effectively conducting this joint aspiration procedure.

Takeaways

• 🦶 The procedure discussed is a landmark-guided ankle arthrocentesis using an anteromedial or anterolateral approach.
• 📍 For the anteromedial approach, identify the medial malleolus and the tibialis anterior tendon, which is easier to locate if the patient extends their great toe.
• 💉 For the anterolateral approach, locate the site between the extensor digitorum longus tendon and the lateral malleolus.
• ❄️ In cases where the patient is allergic to local anesthetics, ice can be used to numb the skin, though typically Lidocaine is injected at the site.
• ⚠️ An alternative anesthetic is a 1% diphenhydramine injection, but it can be more painful than Lidocaine.
• 🧴 Clean the skin with antiseptic solution before the procedure. Use a 10 mL syringe with a 22-gauge, 1.5-inch needle for the aspiration.
• 📏 The needle typically needs to be inserted about 2-3 cm deep, and if needed, sterile gloves can be used to repalpate the landmarks.
• 📐 If synovial fluid isn't immediately aspirated, withdraw the needle slightly and redirect it at a different angle while aspirating.
• 🦴 You can feel a 'crunch' or 'pop' when passing through the joint capsule, indicating proper entry into the joint space.
• 🧪 Once synovial fluid is retrieved, it should be tested for cell count, Gram stain, and culture, with consultation on test prioritization if fluid is limited.

Q & A

What is the first step in performing a landmark-guided ankle arthrocentesis?

The first step is identifying the anatomy for the anteromedial or anterolateral approach by locating key landmarks such as the medial malleolus and the tibialis anterior tendon for the anteromedial approach.

How can the tibialis anterior tendon be better visualized during the procedure?

The tibialis anterior tendon can be more easily seen if the patient extends their great toe.

Where is the needle inserted for the anterolateral approach?

For the anterolateral approach, the needle is inserted between the extensor digitorum longus tendon and the lateral malleolus.

What can be used as an alternative for numbing the skin if a patient is allergic to local anesthetics?

Ice can be used to numb the skin if a patient is allergic to local anesthetics, although Lidocaine or 1% diphenhydramine injection is typically used.

What type of needle and syringe is used for this procedure?

A 10 mL syringe with a 22-gauge, one-and-a-half-inch needle is used for the arthrocentesis procedure.

How can the joint space be opened up for easier needle insertion?

The patient can plantar flex their foot to help open up the joint space for easier needle insertion.

What should be done if synovial fluid is not aspirated after initial needle insertion?

If synovial fluid is not aspirated, the needle should be withdrawn slightly to the superficial dermis, and then redirected at a slightly different angle while continuing to aspirate.

What does it feel like when the needle passes through the joint capsule?

It often feels like a crunch or a pop, similar to the sensation felt when performing a lumbar puncture.

What tests can be performed on the aspirated fluid?

The aspirated fluid can be tested for cell count, Gram stain, and culture, depending on the volume available.

What should be done after withdrawing the needle at the end of the procedure?

After withdrawing the needle, a bandage should be applied to the puncture site.