Arthrocentesis: MTP (Emergency Medicine)

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  • Diagnostic evaluation of acute monoarticular or polyarticular arthritis
  • Therapeutic treatment of acute joint effusions
  • 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
  • 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 (5 mL) with 1-inch, 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
  • Gloves
  • The metatarsophalangeal (MTP) joint is formed by the distal metatarsal and the proximal phalanx of the great toe.
  • The extensor hallucis longus tendon is located superiorly and the flexor hallucis longus tendon is located inferiorly.
  • Needle entry occurs on the dorsal surface medial to the extensor tendon.
  • The anatomy of the interphalangeal (IP) joints of the foot is directly analogous to the IP joints of the hand and to the MTP joint.

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  • Monitor for signs of infection in the region.
  • Treat suspected septic arthritis before formal diagnosis.
    • The choice of antibiotic may be made empirically or may be based on 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.
    • Antihyperuricemia treatment should be delayed.
  • Treatment of pseudogout
    • Treatment is identical to that for acute gout. Antihyperuricemic agents are not used.
  • Complications are uncommon.
  • Iatrogenic infection
  • Iatrogenic hemorrhage
  • Pain during the procedure
  • Reaccumulation of the joint fluid
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