Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia.
J Emerg Med. 2021 May;60(5):633-636. doi: 10.1016/j.jemermed.2020.12.019. Epub 2021 Jan 28.
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.
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.
关节穿刺术是急诊医师（EP）经常进行的一项操作。即时超声（POCUS）已被证明在识别关节积液和引导关节穿刺方面具有很大的潜力。EP 进行的距舟关节穿刺术在文献中尚未有过描述。我们报告了一例使用 POCUS 识别和随后抽吸单纯距舟关节积液的病例。
一名 65 岁男性因无创伤性右踝关节疼痛就诊。就诊时，他的踝关节和中足部周围有弥漫性的温热和水肿。进行 POCUS 以评估踝关节是否存在积液，但未发现积液。然后将超声探头向远端移动，发现距舟关节有积液。炎症标志物升高。磁共振成像扫描显示单纯距舟关节积液，无其他急性发现。然后使用 POCUS 进行关节穿刺术，发现尿酸单钠晶体，符合痛风性关节炎首次发作的特征。
为什么急诊医师应该了解这个病例？：POCUS 为 EP 提供了一种有效的工具，可用于诊断关节积液并引导关节穿刺术。足部由几个小关节组成，超声在这些关节中特别有用。与踝关节类似，这些关节可能会受到化脓性感染和结晶性关节炎的影响。据我们所知，我们首次报告了使用 POCUS 引导 EP 进行的距舟关节穿刺术。介绍了该关节的入路和关节穿刺技术。
