Ankle effusion: open the anterior recess

Question 1Where does ankle joint fluid collect in the anterior view?

1. aIn the anterior recess, deep to the extensor tendons, between tibia and talus
2. bAround the peroneal tendons only
3. cInside the Achilles tendon
4. dUnder the skin over the lateral malleolus

Question 2What makes a small ankle effusion easier to see?

1. aColour Doppler at maximum gain
2. bFirm probe pressure
3. cFull dorsiflexion against resistance
4. dGentle plantarflexion of the foot

Question 3Fluid surrounds an extensor tendon but the recess between the bones is thin. What is it?

1. aTenosynovitis, not a joint effusion
2. bA septic arthritis
3. cA fracture
4. dA normal joint

Question 4A febrile patient has a hot ankle and a distended anterior recess. What next?

1. aAspiration for possible septic arthritis
2. bStrapping and discharge
3. cReassurance
4. dRepeat the scan next week

Question 5Which structure should you avoid when aspirating from the front of the ankle?

1. aThe popliteal vein
2. bThe Achilles tendon
3. cThe dorsalis pedis artery
4. dThe plantar fascia