Ankle Arthrocentesis

Excerpt

Ankle arthrocentesis is an important procedure that can and should be employed to determine the underlying etiology of monoarthropathy of the ankle. There is not always a clear etiology for monoarthropathy of a joint, as the clinical characteristics of the differential often overlap. Proper diagnosis is paramount to ensure the correct management is provided to the patient. The objective information gained by synovial fluid analysis following arthrocentesis can help distinguish between a non-urgent inflammatory process requiring routine anti-inflammatory and pain directed therapy versus an urgent infectious process requiring prompt use of antibiotics and possible surgical intervention. Many etiologies of monoarthropathy may be obvious by clinical history (e.g., hemarthrosis from trauma), but when a clear etiology is not present, arthrocentesis should be performed. Obtaining more objective data to ensure correct diagnosis becomes more paramount in the adult population, as the commonly accepted Kocher criteria used for pediatric septic arthritis does not hold true for the adult population. In rare situations, the existence of septic arthritis and crystal-induced arthritis are not mutually exclusive, and arthrocentesis is again paramount for discovering this occurrence. Access to the joint can also be therapeutic by drainage of a painful effusion or by the ability to inject pharmaceuticals locally.

The advent of improved ultrasound imaging has introduced alternative methods for performing arthrocentesis in comparison to the more traditional landmark-guided methods. The use of ultrasound has been shown to increase the confidence of the provider performing the procedure, accuracy appears to be improved with the use of ultrasound though larger studies are needed to determine whether any superiority in successful arthrocentesis is truly present.