Scanning Technique: Ultrasound-Guided Foot Injection - SonoSite
- 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.
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