- Injection or aspiration
of fluid from the ankle
is best obtained most
of the time anteriorly.
But it really depends on where the fluid
is most easily visible
where the blood vessels are
and what the best approach is
for the angle of the needle.
This is the joint that
we would be aiming for
right at the base of that v.
And if there were fluid there
we would see it as a black area
filling in the base of the v.
This can approached then
with a needle and syringe
using sterile technique
and obviously here do not have sterile gel
or sterile preparation
it's just for demonstration purposes.
The needle can be placed in this way.
Sometimes this is very easy to do
especially when a person has
full mobility of the ankle
and the ankle can be
kept in this orientation.
Sometimes it's necessary to
visualize the effusion this way
holding the transducer transversely.
And then injecting or aspirating
with the needle parallel to the transducer
with the approach this way.
It's very important to watch for arteries
and you can see the artery pulsating
in the center of the field.
When the tranducer's in
the longitudinal plane
it's important to look for blood vessels
and this large vessel that's most likely
the dorsalis pedis artery
is right superficial
to that structure.
It would be very important
for me to move either
medially or laterally
to avoid that artery.
This can also be checked
by switching on the color
and seeing the artery
pulsating right there.
So I would move this
over a little medially
and then enter here
relatively close to the transducer edge
and going in at an angle sufficient
to get down to the depths
where the effusion is.
This joint is approximately
one and a half centimeters deep
and so I'm gonna to have
to angle this syringe
such that the tip of the needle
goes to the depth of two centimeters.
So here is an image of
taken of a person with an ankle effusion.
This is a transverse image.
So we don't really see
the tibiotalar joint
with that classic v presentation
but we see the bone here
and we see an artery probably
the dorsalis pedis artery here
and this hypoechoic
and anechoic black area
is all joint effusion
with synovial proliferation.
In this still image you can
see the needle coming down
and as I turn on the video
you'll see the needle
advanced in injected material
which you can see circulating around.
You can see the artery pulsating.
In this image
this is a person with acute gout.
We have a transverse
image of the left first
metatarsal phalangeal joint
and this is the bone surface.
This is the distal end of the metatarsal
and this area of hypoechoic and anechoic
black appearance is fluid in that joint.
There's a digital artery over here
and the needle can be seen coming down
from the left side of the screen.
You can see the bevel on the needle.
Right now the end of the needle is caught
in a small amount of synovial tissue
and there is steroid injected in.
