arthrography
a method of radiographically visualizing the inside of a synovial joint and related soft tissue structures using contrast medium
- radiopaque, radiolucent (CO2/air), or both types of contrast may be used
arthrography can be done under
- fluoro
- CT
- MRI
joints commonly examined in arthrography
- shoulder
- knee
- hip
- elbow
- wrist
general procedure guidelines of arthrograms
- local anesthetic used in the area of contrast injection
- procedure performed under careful aseptic conditions
- contrast administered under fluoro
- radiographs or spot films may also be taken
general procedure guidelines
- joint effusion, if present, is aspirated after local anesthesia, but before contrast administration
- after contrast is injected, the radiologist manipulates the joint to distribute contrast
patient preparation
- no restrictions on food or drink for arthrogram
- history of allergies established (iodine, anesthetic, contrast)
- patient gowned based on type of arthrogram
- thorough explanation of procedure before the examination, including possible complications
- informed consent form must be signed
equiptment for arthrograms
- fluoro and spot imaging
- conventional x-ray tube capability
- arthrogram tray:
- prep sponge
- fenestrated tape
- syringes
- flexible connector
- needles
- gauze
knee arthrography clincal indications
- tears in joint capsule
- tears or degeneration of menisci
- ligament injury
knee arthrography contraindications
- hypersensitivity to iodine-based contrast media or local anesthetics
knee arthrograms
- assess the knee joint and associated soft tissues
- done with possible tears of the joint capsule, menisci and ligaments are suspected
- done also for non-trauma pathologies (Bakers Cysts)
general procedure: knee
- site prepared
- retropatellar, lateral, anterior, or medial approach
- skin anesthetized
- fluid aspirated
- contrast media instilled (5 mL of positive and 80-100 mL of negative CO2, or air)
- needle removed and knee wrapped
- knee exercised
hip arthrography
most often performed to:
- evaluate congenital hip dislocation in children
- detect loose hip prothesis in adults
- confirm infection in adults, aspirate is sent for analysis
- inject steroid, pain relief or artificial synovial fluid (ie Synvisc) in patients awaiting surgery
common puncture site is:
- 3/4 (1.9 cm) distal to inguinal crease and 3/4 inch (1.9cm) lateral to palpated femoral pulse
shoulder arthrography
the shoulder is the most common arthrogram site
performed to evaluate:
- partial or complete tears in rotator cuff or glenoid labrum
- persistent pain or weakness
- frozen shoulder
- often done in conjunction with MRI afterwards, gadolinium also injected as MRI contrast at the same time
Single or double contrast techniques may be used:
- single uses 0 to 12 mL of positive agent
- double uses 2 to 4 mL of positive agent and 10 to 12 mL of air
what is the most common arthrogram site?
the shoulder
wrist arthrography
the wrist is one of the other more common joints that may be evaluated with arthrography
indications:
- trauma
- persistent pain
- limitation of motion
procedure:
- 1.5 to 4 mL of contrast injected into the dorsal wrist at the articulation of radius, scaphoid, and lunate
- wrist manipulated to disperse contrast
common projections for wrist arthrography
- PA
- lateral
- both obliques
fluoro recommended during rotation to detect leaks
pre procedure for arthrography
- patient completes consent form
- tech sets up applicable tray for procedure
- tech sets up fluoro equiptment
- tech completes all pertinent documentation (consent form, records fluoro time, images taken, lists contrast and medications used and how much, records injection time, records any reaction to contrast, fills out lab requisition if aspirate is sent to the lab)
