What is Arthrography?
Why do physicians order this procedure?
How do I prepare for an arthrogram?
What will the equipment used for my exam look like?
How do x-rays produce a picture of my joint?
How is an arthrogram study performed?
What is Arthrography?
Arthrography is an examination of the joint space. Contrast material is injected into the sac that encompasses the joint (bursa). The sac is clearly visualized using fluoroscopic and static imaging techniques.
During the injection process, the radiologist will observe the flow of contrast material from many angles to determine if there are obstructions to flow or pieces of damaged tissue in the joint. The technologist will also take several static x-rays following the radiologist’s portion of the test.
Why do physicians order this procedure?
An arthrogram is a valuable tool to help your physician determine if a joint is damaged enough to warrant surgery. This could include the need for arthroscopic surgery or more significant surgery such as total joint replacement. Sometimes the exam is performed to help diagnose the source of persistent joint pain.
Joints that are most often examined by arthrography are:
Knee
Hip
Shoulder
Wrist
Ankle
How do I prepare for an arthrogram?
You do not need to restrict food or fluid intake prior to the exam.
To prepare for the exam:
-Inform your physician of any medications you are taking.
-Inform your physician of any substance, medicine or food allergies.
-Mention if you have an allergy to iodine or have experienced an allergic reaction to a previous x-ray/cat scan contrast (a reaction can be as minor as a rash). If you have had a previous reaction to x-ray/cat scan dye (contrast), your physician will want to pre-medicate you to lessen your sensitivity to the dye/contrast the day of your exam.
-If you are pregnant or think you could be pregnant, please notify your physician, the Imaging Department receptionist and the technologist performing your exam prior to the start of the exam. Some imaging tests are not recommended during pregnancy, especially during the first trimester.
-You will be asked to remove jewelry and some articles of clothing on the joint to be examined.
What will the equipment used for my exam look like?
The equipment is comprised of a motorized table, a fluoroscope, x-ray tube and video monitor. The table will be hard and flat, so anticipate some discomfort, especially if you have difficulty lying on hard surfaces. The table has the capability of positioning you in either an upright (standing) position or a horizontal position.
How do x-rays produce a picture of my joint?
Fluoroscopic x-rays employ a continuous dose of x-rays that produce a "real-time" image on the monitor. The advantage of a fluoroscopic exam is that it helps the physician observe the joint while it is being flexed. Some patients only experience discomfort during specific joint motions.
How is the arthrogram study performed?
This procedure is most often performed on an outpatient basis. Prior to the start of the exam, the radiologist, technologist and you will review the exam to be performed to ensure that there are no discrepancies concerning the scheduled exam.
You will be placed on the radiographic table with the joint to be examined exposed for sterile preparation. The technologist will swab the joint with a brown liquid (betadine). The radiologist (physician specialized in x-ray procedures) will inject the joint with contrast material and have you flex the joint several times. While you are on the table, it may be tilted slightly to help the radiologist better visualize the joint. The radiologist will take x-rays during this portion of the exam. Following this first part of the exam (fluoroscopic exam) the technologist will take additional still (static) pictures of the joint.
If your physician has also ordered an MRI of the joint, you will have that procedure soon after the arthrogram injection. When only MRI images are required of the joint, the radiologist will inject MRI contrast and not take static x-rays.
The x-ray arthrogram exam usually takes about 45 -60 minutes; MRI arthrograms take 90 minutes.
What should I expect during and after the procedure?
When you arrive at Liberty Hospital you will report to the Registrations Department on the first floor. Following the registration process you will be taken to the Diagnostic Imaging Department where either the x-ray or MRI arthrogram will be performed. The procedure will be performed by a radiologist and a radiologic technologist.
The radiologist injects a local anesthetic in the area where the contrast will be injected into the joint. This is done with a small needle, so you should not experience discomfort with this part of the exam. After the contrast in injected into the joint, you will be asked to rotate or bend the joint to disperse the contrast evenly throughout the sac (bursa). This process will probably be uncomfortable, but will only last for a few motions in each direction.
The radiologist and technologist will take a series of static x-rays, if a radiographic arthrogram, or you will be moved to MRI for the remainder of the exam.
Your joint will be sore for a couple of days following the exam due to movement during the contrast distribution exercises.
What are the benefits and risks of having an arthrogram?
-This procedure is effective for detecting lesions or tears of the ligaments of the joints, especially the knee, wrist, elbow and rotator cuff tears associated with shoulder dislocations
-You will not become radioactive from an arthrographic examination.
-You may experience a mild reaction to the contrast, but this is rare with non-ionic contrast.
-A woman should always inform the radiologist and/or radiology technologist if she thinks she may be pregnant.
What are the limitations of arthrography?
-Incomplete or partial tears of the rotator cuff may not be seen during this exam.
-An MRI may be required following injection of contrast to see many types of abnormalities.
