Arthrocentesis: Ankle (Orthopaedics)

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Diagnostic evaluation of acute monoarticular or polyarticular arthritis
  • Therapeutic treatment of acute joint effusions
CONTRAINDICATIONS
  • Overlying skin infections or lesions
  • Arthrocentesis is probably safe in patients with a coagulopathy, unless the coagulopathy is severe. However, the safety of arthrocentesis in patients with abnormal coagulation is not established.
  • Bacteremia
EQUIPMENT
  • Skin cleansing agent (e.g., chlorhexidine or povidone-iodine)
  • Sterile gauze
  • Local anesthetic (1% lidocaine is acceptable)
  • Small (e.g., 5 mL) syringe with 25-gauge needle for anesthetic injection
  • Syringe (10 mL) with 1-inch 20- or 22-gauge needle for joint aspiration
  • Specimen tubes for submission of synovial fluid to the laboratory; typically, an EDTA tube is used for cell count and differential, and a lithium heparin tube is used for crystal examination
  • Bandage
  • Elastic wrap (to be applied after large joint aspirations)
  • Sterile gloves, mask, goggles
ANATOMY
  • The ankle joint is formed by the distal tibia and fibula and the talus.
  • The tibialis anterior tendon lies just anterior to the medial malleolus and inserts on the first metatarsal and distal medial cuneiform bone and assists in dorsiflexion of the foot.
  • The dorsalis pedis artery lies medial to the tibialis anterior tendon.
  • Needle entry occurs midway between the tibialis anterior tendon and the medial malleolus.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Monitor for signs of infection in the region.
  • An elastic bandage may be placed around larger joints to provide patient comfort and reduce re-accumulation of the effusion.
  • Treat suspected septic arthritis before formal diagnosis.
    • The choice of antibiotic may be made empirically, or based upon the gram stain results.
    • Intraarticular antibiotics are not recommended.
    • The joint capsule must be repeatedly drained until the effusion is cleared. Operative drainage may be needed.
  • Treatment of gout
    • High-dose nonsteroidal antiinflammatory agents, colchicine, and oral steroids may be used
    • Anti-hyperuricemia treatment should be delayed.
  • Treatment of pseudogout
    • Treatment is identical to that for acute gout. Antihyperuricemic agents are not utilized.
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