What is Arthography
Radiography of a joint, joint capsule, soft tissue or cartilage
good time to work on sterile tray set up
dont wear gown just drape area
What machinery is used in arthrography
- Requires contrast to see these structures
- Requires fluoroscopy and potentially an
overhead tube - Contrast media
What is negative contrast
- air
- Large amounts needed (150 ml)
- Very painful (distention)
- Least accurate diagnosis
What is positive Contrast
- Iodinated compound
- Readily absorbed, greater accuracy
- Smaller amounts, less painful
Visipaque Omnipaque
What is double contrast
- Both negative and positive
- Best of methods at producing an accurate diagnosis
- Smaller amounts of both contrast agents used
What did they used to do for joint arthrogram study with double contrast (Previous)
- Joints exercised and manipulated (valgus and varus stress to fill the joint w contrast)
- Cross-table images
- Multiple positions, careful positioning,
stress views - Excellent for knee pathology
What is wrong in this arthrogram
- tear in meniscus allowing contrast to leak out
(Previous)Pathologic Indications for Arthogram
- Tears in joint capsule
- Tears or degeneration of menisci
- Ligament injury
- Loose bodies
Criteria for Arthographic Imaging
- Entire capsule is outlined
- proper AP and lateral positions
- markers
Arthogram for Meniscal Imaging
- Double contrast study
- Cross-table imaging required
- Contrast injected into the lateral aspect of the suprapatellar recess (soft spot on the lateral side of the knee)
- Images taken from prone to lateral to
supine, rotating the knee 30 degrees
each exposure
Varus stress (pulling foot towards midline): LCL
What is seen in this image
- AP knee image for meniscal tear
- 30° rotation of knee between exposures
- Six views per image receptor
Left: Torn meniscus
Right: Normal meniscus
MRI has taken over for knee arthogram
How are arthograms done now
- MRI and US are non-invasive
- Less risk and better diagnosis
- Have replaced arthrograms for the most
part - MRI demonstrates MOST pathologies
involving ligaments and tendons and joint capsule without needing an injection - Current arthrograms use positive
contrast only
some things still require an injection
Meniscus does not
Labrum does
What is a SLAP lesion
long head of bicep torn off labrum at 12 o clock (rips it from 9-3)
Current Arthography Equipment
Fluoroscopy and spot
imaging
Conventional X-ray tube
capability
Typically in same room (can both go over table)
What is on an Arthrogram Tray:
– Prep sponge
– Fenestrated drape
– Syringes
– Flexible connector
– Needles
- marker to mark where injection is going in
Steps of Arthogram Procedure
- EXPLAIN procedure to patient
- Consent form signed
- Patient supine
- Preliminary image (for localization)
- Aseptic procedure
- Local anesthetic (lidocaine injected with 25G needle
- May aspirate some fluid
- Injection of contrast(s) into joint capsule under fluoroscopy
**MRT’s must be able to add items to a sterile tray without contaminating the sterile field **
Current Uses of Arthography
- Joint aspiration
- Joint injection
- Arthrogram Pre-MRI
- Must coordinate MRI and fluoro
What is a joint aspiration
- similar to needle aspiration biopsy
- used on patients who have a joint replacement
- sample sent out to the lab to rule out infection
- patient would have PICC line
need to redo to confirm infection is gone
What is a Joint injection
therapeutic to try and reduce pain in joint. (steroid, hyaluronic acid joint injections – Synvisc, Orthovisc, Neovisc, etc )
- pain releif (oil change in joint)
dont need fluoro with knee but need it with hip
What is an Arthogram Pre MRI
- Some pathologies are not demonstrated with MRI
- A Labral tear in the shoulder is an example
- To see labral tears, contrast must be used
- MRI contrast is gadolinium (not seen with fluoro)
- Iodinated contrast and gadolinium mixed
- Fluoro can then be used to ensure that
gadolinium has been injected into the joint
What is seen in this image
- slight tear in lateral horn of posterior meniscus
- no contrast required for MRI
What is happening in these images
normal vs torn ACL
Possible Complications of Arhtographys (from contrast and technique)
From contrast
- Allergic reaction
- Chemical synovitis (inflammation of synovial cavity)
From technique
- Pain
- Infection
- Distension of joint producing discomfort
- Vasovagal reaction (fainting)
