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The Journal of Emergency Medicine May 2021Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint...
BACKGROUND
Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint effusions and guiding arthrocentesis procedures. EP-performed talonavicular joint arthrocentesis has not been previously described in the literature. We present a case in which an isolated talonavicular joint effusion was identified and then subsequently aspirated using POCUS.
CASE REPORT
A 65-year-old man presented with atraumatic right ankle pain. On arrival, he was noted to have diffuse warmth and edema around the ankle and midfoot. POCUS was performed to evaluate for an ankle joint effusion, which was not present. The ultrasound was then moved distally, where a talonavicular joint effusion was noted. Inflammatory markers were found to be elevated. A magnetic resonance imaging scan revealed an isolated talonavicular joint effusion without additional acute findings. POCUS was then used to perform an arthrocentesis, which revealed monosodium urate crystals consistent with an initial episode of gouty arthritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS provides the EP with an efficient tool to diagnose joint effusions and guide arthrocentesis procedures. The foot is composed of several small joints where ultrasound can be particularly helpful. Similar to the ankle joint, these joints can be afflicted with pyogenic infections and crystalline arthropathies. To our knowledge, we present the first report of EP-performed talonavicular arthrocentesis guided by POCUS. The approach to this joint and technique for arthrocentesis are presented.
Topics: Aged; Ankle Joint; Arthrocentesis; Humans; Male; Point-of-Care Testing; Ultrasonography; Ultrasonography, Interventional
PubMed: 33516576
DOI: 10.1016/j.jemermed.2020.12.019 -
Journal of Oral and Maxillofacial... Aug 2020
Topics: Arthrocentesis; Humans; Temporomandibular Joint
PubMed: 32461063
DOI: 10.1016/j.joms.2020.04.029 -
Atlas of the Oral and Maxillofacial... Sep 2022The introduction of temporomandibular joint (TMJ) arthroscopy by Onishi in 1970 (results published in 1975 and 1980) opened a new modality for TMJ treatment. The... (Review)
Review
The introduction of temporomandibular joint (TMJ) arthroscopy by Onishi in 1970 (results published in 1975 and 1980) opened a new modality for TMJ treatment. The efficiency of arthroscopic lavage and lysis led in the 1990s to its simplification: TMJ arthrocentesis. Always associated with load control, physiotherapy, and elimination of any occlusal hazards, arthrocentesis, a simple procedure, entails less expensive and more available tools and is performed under local anesthesia. Although lacking direct visual inspection of the joint structures, it has become quite popular. Arthrocentesis is most efficient in localized joint pain and limited joint movements such as closed lock, anchored disc phenomenon, osteoarthritis, and various inflammatory diseases. In clicking joint, the results are somewhat controversial. The efficiency of arthrocentesis elicited many enquiries that led to the study and a better understanding of joint function and dysfunction and the actual role of disc location. The release of closed lock without disc repositioning was quite surprising; it improved our understanding of the pathogenesis of closed lock and led to the discovery of the anchored disc phenomenon. This was followed by the awareness of the joint-lubrication system and, in turn, alternative suggestions for the pathogenesis of TMJ disc displacement with and without reduction, open lock, and osteoarthritis, and ultimately by the development of an effective bio-lubricant. Awareness of the role of joint overloading led to the development of an interocclusal appliance that reduces intraarticular pressure; it has become a "must" support for arthrocentesis and any surgical intervention. In our view, arthrocentesis is the definitive indication of the need for surgical intervention and, therefore, should be the first in the cascade of interventions in TMJ disorders.
Topics: Arthroscopy; Humans; Lubricants; Osteoarthritis; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 36116872
DOI: 10.1016/j.cxom.2022.06.008 -
Hand Clinics Aug 2020Infections in the joints of the hand and wrist carry the risk of significant morbidity. Common presenting symptoms include joint redness, swelling, and pseudoparalysis... (Review)
Review
Infections in the joints of the hand and wrist carry the risk of significant morbidity. Common presenting symptoms include joint redness, swelling, and pseudoparalysis that occurs several days following a penetrating trauma. Diagnostic workup should be expedited, including a laboratory evaluation and arthrocentesis. Imaging, including radiographs, ultrasound, computed tomography, and/or MRI, are helpful tools in diagnosis. Once infection is identified, prompt surgical debridement and antibiotics are required. Once the infection has been managed, hand therapy is initiated to decrease the risk of stiffness. Stiffness is the most common complication following infection; additional reported complications include arthritis, ankylosis, and amputation."
Topics: Algorithms; Anti-Bacterial Agents; Arthritis, Infectious; Arthroscopy; Debridement; Drainage; Finger Joint; Humans; Immunocompromised Host; Wrist Joint
PubMed: 32586459
DOI: 10.1016/j.hcl.2020.03.006 -
Revista Espanola de Patologia :... 2020Synovial fluid samples represent only a very small percentage of routine work in a cytology laboratory. However, its microscopic examination allows us to observe... (Review)
Review
Synovial fluid samples represent only a very small percentage of routine work in a cytology laboratory. However, its microscopic examination allows us to observe different types of cells, particles and structures that, due to their morphological characteristics, may provide relevant data for cytodiagnosis. We present certain aspects related to arthrocentesis, the relationship between the gross appearance of synovial fluid and certain pathological processes, as well as the different techniques for processing and staining the smears. Furthermore, we describe the main cytological findings in various pathological conditions of the synovial joints, such as infections (bacterial and fungal), non-infectious inflammatory type (osteoarthrosis, rheumatoid arthritis, connective tissue diseases) and tumoral, distinguishing between primary and metastatic, both solid and haematological neoplasms.
Topics: Arthrocentesis; Bacterial Infections; Crystallography; Cytodiagnosis; Humans; Joint Diseases; Mycoses; Neoplasm Metastasis; Neoplasms; Staining and Labeling; Synovial Fluid; Synovial Membrane
PubMed: 32199591
DOI: 10.1016/j.patol.2019.01.004