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, 3] 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. [4] 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.
Indications
Diagnostic indications for ankle arthrocentesis include the following:
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Evaluation of monoarticular arthritis [5]
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Evaluation of suspected septic arthritis [6]
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Evaluation of joint effusion
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Identification of intra-articular fracture
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Identification of crystal arthropathy [7]
Therapeutic indications include the following:
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Relief of pain by aspirating effusion (including hemarthrosis)
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Injection of medications [8] (eg, corticosteroids, antibiotics, anesthetics)
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Drainage of septic effusion
Contraindications
There are no absolute contraindications for ankle arthrocentesis.
Relative contraindications include the following:
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Suspected septic joint - In this case, no contraindications exist
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Cellulitis overlying the joint
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Skin lesion or dermatitis overlying the joint
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Known bacteremia
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Adjacent osteomyelitis
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Uncontrolled coagulopathy
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Joint prosthesis