Ankle Arthrocentesis

Updated: May 16, 2016
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Overview

Background

Arthrocentesis (synovial fluid aspiration) can be performed diagnostically (for identification of the etiology of acute arthritis) or therapeutically (for pain relief, drainage of effusion, or injection of medications). [1, 2] The clinician performing the procedure should be familiar with the anatomy of the specific joint in order to avoid puncture of tendons, blood vessels, and nerves. [3] Using the extensor surface of the joint for needle insertion, while keeping the joint in minimal flexion, minimizes the risk of such injuries.

The ankle joint is a hinged synovial joint with primarily up-and-down movement (plantarflexion and dorsiflexion). However, when the ranges of motion (ROMs) of the ankle and subtalar joints (talocalcaneal and talocalcaneonavicular) are taken together, the complex functions as a universal joint. For more information about the relevant anatomy, see Ankle Joint Anatomy.

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Indications

Diagnostic indications for ankle arthrocentesis include the following:

  • Evaluation of monoarticular arthritis [4]
  • Evaluation of suspected septic arthritis [5]
  • Evaluation of joint effusion
  • Identification of intra-articular fracture
  • Identification of crystal arthropathy [6]

Therapeutic indications include the following:

  • Relief of pain by aspirating effusion or blood
  • Injection of medications [7] (eg, corticosteroids, antibiotics, anesthetics)
  • Drainage of septic effusion
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Contraindications

There are no absolute contraindications for ankle arthrocentesis.

Relative contraindications include the following:

  • Suspected septic joint - In this case, no contraindications exist
  • Cellulitis overlying the joint - If arthrocentesis is performed, the patient should be admitted for intravenous antibiotics, even if the synovial fluid is not suspicious for infectious arthritis
  • Skin lesion or dermatitis overlying the joint
  • Known bacteremia
  • Adjacent osteomyelitis
  • Uncontrolled coagulopathy
  • Joint prosthesis - Preferably, a joint prosthesis is tapped by an orthopedist
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