Small Joint Arthrocentesis
Other Names
- Toe Arthrocentesis
- Finger Arthrocentesis
- Thumb Arthrocentesis
- Foot Arthrocentesis
Background
- This page covers small joint arthrocentesis
- Includes all of the small joints in the hand and foot
Anatomy
- Joints include (but not limited to):
- Hand
- Foot
Indications
- Rule out Septic Arthritis
- Diagnose Gout or other spondyloarthropathy
- Symptomatic relief
- Unexplained joint effusion or monoarthritis
Contraindications
- Absolute
- No absolute contraindications
- Relative
- Abnormal or altered anatomy
- Overlying infection or bacteremia
- Coagulation
- Prosthetic joint
- Uncooperative patient
- Diagnosis can be made with less invasive method
Procedure
Equipment
- Sterile gloves
- Sterile gauze
- Antiseptic (e.g. chlorhexidine, iodine or alcohol)
- Syringe (3-5 mL is typically sufficient)
- Needles (large bore for drawing up local, small gauge for injection)
- Small joints recommend 21 - 23 gauge, 0.5 - 1 inch needle
- Anesthetic (e.g. 1-2% lidocaine or 0.5% bupivacaine)
- Ultrasound machine (optional, but highly recommended)
- High frequency linear probe
- Sterile ultrasound probe cover
Preparation
- Patient positioning
- For the upper extremity, the patient is seated with hand on table
- For lower extremity, the patient is supine with hip and knee flexed, foot on table
- Palpate joint
- Important to try to find "dip" between bones
- This is where the needle will be inserted
- Ultrasound
- Can confirm effusion is present
- Helpful to identify optimal approach
- Avoids any underlying neurovascular structures
Palpation Guided Technique
- Identify bony landmark
- Point of maximal depth between two bones of interest
- Mark estimated point of entry
- Sterile prep your field
- Insert needle directed into joint space
- Aspirate while advancing
- Needle should "drop" into joint
- May require subtle redirections to get into joint
Ultrasound Guided Technique
- Identify landmark(s) sonographically
- The joint should be centered on the screen in long axis
- Identify optimal approach for needle
- Technique
- In- or out-of-plane technique can be used
- Out-of-plane tends to be easier in small joints
- In-plane
- Advance needle as you advance into joint
- Can be difficult with linear probe over small joints
- Out-of-plane
- Follow needle tip in a "step-wise" approach
- Needle tip should be visualized in joint space
- Aspirate as you advance
Aftercare
- Apply bandage
- Consider ace wrap to help prevent recurrence of effusion
Complications
- Pain
- Infection
- Recurrence of effusion
- Damage to surrounding soft tissue structures
See Also
References
- ↑ Image courtesy of emra.com, "Small Spaces: Ultrasound-Guided Small Joint Aspiration"
Created by:
John Kiel on 26 January 2023 07:19:04
Authors:
Last edited:
26 January 2023 08:19:21
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