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ABSTRACT: The metatarsophalangeal (MTP) joints can be difficult to access for aspiration and injection; try a dorsolateral or dorsomedial approach. Pull traction on the affected toe and locate the resulting recess between the respective phalanges and metatarsal bones. Move the toe through full plantar flexion and dorsiflexion to help identify the space between the proximal and distal borders. Identifying surface anatomy on an inflamed joint can be difficult; palpate the surface anatomy of the contralateral toe for comparison. Aspirating fluid from the first MTP joint in a patient with gout can be difficult; use intra-articular anesthetic injection first. "Spritzing" the needle contents on a slide may reveal enough fluid or blood for crystal analysis. (J Musculoskel Med. 2007;24:517-518)
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This is the fifth in a special series of articles on joint aspiration and injection.
The metatarsophalangeal (MTP) joints are superficial joints affected frequently in gout and rheumatoid arthritis and, in some cases, advanced osteoarthritis. Physicians often rely on aspiration and fluid analysis of these joints in establishing a diagnosis. Local injection is a reasonable alternative to systemic therapy, particularly in monoarticular gout.
The MTP joints...