To do a landmark guided ankle arthrocentesis start by identifying the anatomy.
Anteromedial approach (shown in video):
Locate the medial malleolus and the tibialis anterior tendon, which is more easily seen if the patient extends their great toe. Between these structures is where you will insert the needle.
Anterolateral approach:
The needle insertion site is between the extensor digitorum longus tendon and the lateral malleolus.
Palpate the landmarks and leave a mark or skin impression at the site. Clean the skin with antiseptic solution. We’re using a 10 mL syringe with a 22 gauge 1.5 inch needle. If you use sterile gloves you can keep one hand sterile to re-palpate your landmarks. If the patient plantar flexes it will help open up the joint space.
Insert the needle perpendicular to the skin. Aspirate as you advance the needle. You usually have to go about 2-3 cm deep. Remove as much fluid as can be withdrawn, especially if it looks purulent. Once the needle is withdrawn apply a bandage.