We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Ankle Joint Injection

From WikiSM
Jump to: navigation, search

Other Names

  • Ankle Joint Injection
  • Tibiotalar Joint Injection

Background

Ultrasound guided approach in plane

Anatomy

  • Ankle Joint
    • Formed by the articulation of the distal tibia, distal fibula and talus
    • Hinge joint permitting dorsiflexion and plantarflexion

Indications


Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Tendon tear or rupture
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Patient positioning with knee and hip flexed, ankle plantarflexed and foot flat on the table

Equipment

  • Sterile including chloraprep, chlorhexadine, iodine
  • Ultrasound with sterile probe cover
  • Gloves
  • Needle: typically 25 gauge, 0.5-1 inch
  • Syringe: 1-3 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid

Preparation

  • Place ultrasound on opposite side of patient
  • Identify sonographic landmarks

Palpation Guided Anterior Approach

Anteromedial approach for palpation guided injection. The anterior edge of the medial malleolus and tibialis anterior tendon represent the boarders.
  • Position
    • Patient is supine
    • Hip and Knee flexed, foot in plantarflexion resting on examination table
  • Anterior/ Medial Approach Landmarks
    • Target: between medial malleolus and tibialis anterior tendon
    • Palpate 1 cm anterior to medial malleolus, identify tibia and talus
    • Identify extensor hallucis longus, tibialis anterior tendons (ask patient to dorsiflex great toe and foot respectively)
    • Mark skin between medial malleolus and the two tendons
    • Note: this allows avoidance of the dorsalis pedis and posterior tibial neurovascular structures
  • Lateral Approach Landmarks
    • Target: just anterior to lateral malleolus
    • Palpate and mark skin anterior to lateral malleolus
  • Prep skin, provide cutaneous anesthesia as indicated
  • Injection
    • Needle is directed slightly posterior across the ankle joint
    • Needle is roughly parallel to dorsum of foot
    • Advance needle until you feel a pop, entering the synovial membrane
    • The needle vector may require subtle redirection to ensure placement in the joint space
    • Aspirate to ensure there is no blood return, then inject
  • After procedure, apply pressure to tamponade any bleeding
  • Apply bandage

Ultrasound Guided Approach

Ultrasound guided approach in long axis with in-plane technique
  • Position
    • Patient is supine
    • Hip and Knee flexed, foot in plantarflexion resting on examination table
  • Position
    • Place probe in long axis just medial to the tibialis anterior tendon
    • Confirm location of the anterior neurovascular bundle
    • Localise the anterior recess of the tibiotalar joint
  • Prep skin, provide cutaneous anesthesia as indicated
  • Needle insertion
    • Long axis: distal to proximal at about a 30° angle passing over the talar dome aimed cranially
    • Short axis is also an option
    • Position needle tip just past the joint capsule in the anterior recess of the joint
  • After procedure, apply pressure to tamponade any bleeding
  • Apply bandage

Aftercare

  • No major restrictions in most cases
  • Can augment with ice, NSAIDS

Complications

  • Infection
  • Damage to surrounding tissue

See Also


References

Created by:
Jesse Fodero on 14 July 2019 20:36:29
Authors:
Last edited:
5 November 2023 13:54:20
Category: