Arthrography

Definition

Arthrograpy is a procedure involving multiple x rays of a joint using a fluoroscope, a special piece of x-ray equipment that shows an immediate x-ray image. A contrast medium (in this case, a contrast iodine solution) injected into the joint area helps highlight structures of the joint.

Purpose

Frequently, arthrography is ordered to determine the cause of unexplained joint pain. This fluoroscopic procedure can show the internal workings of specific joints and outline soft tissue structures. The procedure may also be conducted to identify problems with the ligaments, cartilage, tendons, or the joint capsule of the hip, shoulder, knee, ankle, wrist, or other joints. An arthrography procedure may locate cysts in the joint area, evaluate problems with the joint's arrangement and function, indicate the need for joint replacement, or show problems with existing joint replacement (prostheses). The most commonly studied joints are the knee and shoulder.

Description

Arthrograpy may be referred to as "joint radiography" or "x rays of the joint." The term arthrogram may be used interchangeably with arthrography. The joint area will be cleaned and a local anesthetic will be injected into the tissues around the joint to reduce pain. Next, if fluids are present in the joint, the physician may suction them out (aspirate) with a needle. These fluids may be sent to a laboratory for further study. Contrast agents are then injected into the joint through the same location by attaching the aspirating needle to a syringe containing the contrast medium. The purpose of contrast agents in x-ray procedures is to help highlight details of areas under study by making them opaque. Agents for arthrography are generally air- and water-soluble dyes, the most common containing iodine. Air and iodine may be used together or independently. After the contrast agent is administered, the site of injection will be sealed, and the patient may be asked to bend and flex the joint to distribute the contrast.

Before the contrast medium can be absorbed by the joint itself, several films will be quickly taken under the guidance of the fluoroscope. The patient will be asked to move the joint into a series of positions, keeping still between positioning. Sometimes, the patient will experience some tingling or discomfort during the procedure, which is normal and due to the contrast. Following fluoroscopic tracking of the contrast, standard x rays of the area may also be taken. The entire procedure will last about one hour.

Generally, a joint is evaluated first by MRI ( magnetic resonance imaging ) instead of an arthrogram, or by MRI combined with the arthrogram. Gadolinium, an MRI contrast agent, is injected if the arthrogram is performed as part of an MRI procedure. If the arthrogram is performed as part of a MRI arthrogram, the MRI scan will then be obtained immediately afterward.

Preparation

It is important to discuss any known sensitivity to local anesthetics or iodine prior to this procedure. A physician should explain the procedure and the risks associated with contrast agents and ask the patient to sign an informed consent . If iodine contrast will be administered, the patient may be instructed not to eat before the exam. The timeframe of fasting may range from only 90 minutes prior to the exam up to the night before. There is no other preparation necessary.

Aftercare

The affected joint should be rested for approximately 12 hours following the procedure. The joint may be wrapped in an elastic bandage, and the patient should receive instructions on the care and changing of the bandage. Noises in the joint such as cracking or clicking are normal for a few days following arthrography. These noises are the result of liquid in the joints. Swelling may also occur and can be treated with application of ice or cold packs. A mild pain reliever can be used to lessen pain in the first few days. However, if any of these symptoms persist for more than a few days, patients are advised to contact their physician.

Risks

In some patients iodine can cause allergic reactions, ranging from mild nausea to severe cardiovascular or nervous system complications. Since the contrast dye is put into a joint, rather than into a vein, allergic reactions are rare. Facilities licensed to perform contrast exams should meet requirements for equipment, supplies, and staff training to handle a possible severe reaction. Infection or joint damage are possible, although not frequent, complications of arthrography.

Normal results

A normal arthrography exam will show proper placement of the dye or contrast medium throughout the joint structures, joint space, cartilage, and ligaments.

Abnormal results

The abnormal placement of dye may indicate rheumatoid arthritis, cysts, joint dislocation, tear of the rotator cuff, tears in the ligament, and other conditions. The entire lining of the joint becomes opaque from the technique, which allows the radiologist to see abnormalities in the intricate workings of the joint. In the case of recurrent shoulder dislocations, arthrography results can be used to evaluate damage. Patients with hip prostheses may receive arthrography to evaluate proper placement or function of their prostheses.

Resources

BOOKS

Juhl, John H., and Andrew B. Crummy. Paul and Juhl's Essentials of Radiologic Imaging. Philadelphia: J. B. Lippincott Co., 1993.

ORGANIZATIONS

American College of Radiology. 1891 Preston White Drive, Reston, VA 22091. (800) 227-5463. http://www.acr.org .

Arthritis Foundation. 1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. http://www.arthritis.org .

Teresa Norris, RN

Lee A. Shratter, MD