Ultrasound Versus Landmarks for Great Toe Arthrocentesis

Several studies have demonstrated ultrasound (US) is superior to traditional landmark (LM)-based techniques for large and medium joint aspiration; however, no studies of sufficient size have evaluated these interventions in the smaller toe joints. The purpose of this study was to determine if US provides an advantage over LM for successful first-pass aspiration of first metatarsophalangeal joint (1st MTPJ) effusions.

A cross-over, cadaveric trial evaluating the interventions of US and LM. Eighteen emergency medicine residents performed four US and four LM aspirations each of 1st MTPJ effusions simulated in fresh-frozen cadavers. The initial intervention utilized was randomized. The primary outcome measured was aspiration success or failure. A secondary outcome measured was time in seconds taken to complete a successful aspiration.

A total of 144 1st MTPJ aspirations were attempted-72 by US and 72 by LM. US was the initial intervention used in 9 of 18 (50%) participants. Fifty-seven of 72 (79.2%) US attempts were successful, while 53 of 72 (73.6%) LM attempts were successful (95% confidence interval 69.5%, 83.3%; p = 0.56). Successful US aspirations took 43.7 seconds (±31.0), whereas successful LM aspirations averaged 34.0 seconds (±24.3). The mean difference in time to successful aspiration was 9.7 seconds (95% confidence interval 20.3, -0.9; p = 0.07). There was no statistically significant difference in success and time between US and LM.

In this study, US did not prove superior to LM for first-pass aspiration of 1st MTPJ effusions.