Arthrograms are a diagnostic tool performed in conjunction with MRI, CT or X-ray to evaluate joints. This procedure involves a contrast injection into the joint that enhances the visualization of structures and aids the evaluation of joint abnormalities, such as cartilage tears and other injuries.
Fluoroscopy makes it possible to see internal organs in motion. When contrast is injected into the joint space, it coats the inner lining of the joint structures and appears bright white on an arthrogram, allowing the radiologist to assess the anatomy and function of the joint.
How does the procedure work?
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
Fluoroscopy uses a continuous x-ray beam to create a sequence of images that allow the radiologist to view the anatomy in real time on a screen similar to a television monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view internal organs in motion. Still images are also captured and stored either on film or electronically on a computer.
Today, most images are digital files that are stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.
What to Expect:
After local anesthesia, a needle is maneuvered into the area of interest under fluoroscopic guidance. Correct needle placement is confirmed by using a combination of imaging and injection of a small amount of iodinated contrast. A combination of a short-acting anesthetic, such as bupivacaine or ropivicaine, and an intermediate to long acting corticosteroid, such as triamcinolone, are then injected. The anesthetic can provide immediate pain relief lasting 4-6 hours while the corticosteroid takes effect approximately 1-2 days after the injection, reaching maximum effectiveness within 5-7 days. The duration of the pain relief varies depending on the severity and reversibility of the patient’s condition. If therapeutic effect is achieved, several injections per year can be performed with few long term consequences.
The procedure is most often used to identify abnormalities within the:
The procedure is also used to help diagnose persistent, unexplained joint pain or discomfort.
Frequently Asked Questions
After local anesthetic, the radiologist will insert a needle into the joint using X-ray guidance and inject contrast material. If needed for further diagnosis, you will be taken to the CT or MRI machines for more images.
You may resume normal daily activities with the exception of athletic activities, which should be avoided for 24 hours. Athletes should consult their coach or trainer prior to resuming practice. You may experience minor discomfort and swelling of the joint for a day or two after the arthrogram. You may treat the pain with over-the-counter non-steroidal anti-inflammatory medicines such as Advil or Tylenol.
A few patients may have allergic reaction from the contrast material. Please inform the technologist prior to your exam if you have any known allergy to x-ray contrast or MRI contrast.
Infection of the joint is a rare but serious complication of arthrography and requires treatment with antibiotics. If you have symptoms of pain, swelling, red skin or fever three or more days after the arthrogram, please contact the facility to speak to the radiologist or your referring physician.
No special preparation is necessary before arthrography. Food and fluid intake do not need to be restricted.
You should inform your physician of any medications you are taking and if you have any allergies, especially to barium or iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.