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.
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.
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.
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.
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.
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.
A normal arthrography exam will show proper placement of the dye or contrast medium throughout the joint structures, joint space, cartilage, and ligaments.
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.
Juhl, John H., and Andrew B. Crummy. Paul and Juhl's Essentials of Radiologic Imaging. Philadelphia: J. B. Lippincott Co., 1993.
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
Good luck to all who read this. I am glad I can review with a smile. Thanks to CDI.
Feels very strange and very sore!! My dr can't explain to me what or why this has happened the results showed a healthy hip joint. Not so sure it is now rhough any advice please!!!
I had this procedure done in France, in my wrist to check the ligament in my thumb. Before the arthrography the radiologist asked me which ligament he was to test! Excrutiating pain for days afterwards. Could not brush my hair hold a folk. 10 days later still lots of pain. Saw radio and he said "Oh, someone had a complication this day". He went to check the records and told me it was me. He had injected iodine into the tendon (and maybe radial nerve).
I went back to the surgeon who proposed the surgery and he gave me an examination for free but now diagnosis. The hospital never replied to a letter of complaint (signed for delivery) - Polyclinique Aguilera, Biarritz, Dr Monteiro. The pain gradually got less but it never disappeared. I have a burning sensation in my wrist when ever I type or use my fingers. I had to stop studying my degree (I later finished) and have to stop writing every few minutes. I am handicapped, I can't type! My quality of life has reduced drastically.
I have seen numerous professionals including two neurologists, two surgeons, and GPs. No-one know what it is. It is ruining my life. Can anyone give me any advice? If not, I just want to make you aware that complications happen.
I took a Xanax before my appointment because I was feeling stressed and anxious. They had me lie down on the xray table and they covered my face and neck with a sterile cloth so I couldn't see what they were doing. The doctor did not explain much of anything to me. He just told me that the initial shot was anesthesia and that it would sting, and it did a little bit. After that, he went in with another needle and I felt scraping in the joint. He would check his machine for something and go in again with the needle. He did this 4 or 5 times. I don't know why he had to go in so many times. Finally, he said he was going to inject the contrast and that my shoulder would feel full.
After he administered the contrast, I went to the bathroom to change out of the hospital gown. In about a minute, I felt blood rush to my head, and I was severely lightheaded and dizzy. I could barely put on my clothes. When I turned around to leave the bathroom, I almost fell over. I walked out and the nurse asked if I was okay, and I was not. I had blurred vision and heard buzzing in my ears. She assisted me to a chair, where I had trouble sitting down. She called another nurse in to check my vitals. I had high blood pressure but they suspected it was due to my nerves.
They said that reaction does not normally happen. They said it could have been a mixture of my stress and anxiety and a little reaction to the contrast and maybe a little reaction with the Xanax. With all of this going on, I started to get a migraine (I also get chronic migraines).
Suffice it to say that the MRI part of the procedure was also horrible, because of my claustrophobia and the migraine I had just got. The whole procedure took about two hours, because of all the setbacks.
I really hope I never have to go through this again.
Try going in with a positive attitude and good breathing technique (Yoga style works for me!). The value of the MRA should be appreciated. It can reveal and/or rule out issues which the standard MRI can not. For those of you suffering in pain for years with no definitive diagnosis, it could be, as it was for me, the tool which will finally provide the answers you seek and placement on the path to pain relief and healing.
However, progressively the pain has gotten worse - way worse than even before my diagnosis of osteoarthritis - very sore dull ache but coupled with excruciating sharp pains with each movement. I can barely put weight on the leg, it hurts to move it, and even lying down doesn't seem to relieve any of the pain. The doctor prescribed codeine which ive been taking with paracetamol and ibuprofen but it hasnt touched the pain.
ive been in tears for hours at the intensity of the soreness that seems to throb and at times a sensation that resembles the heavy feeling during the injection. it almost feels like the leg is too long and to put weight on it / straighten it would push the hip through the socket. it feels like i need my leg pulled out, cleaned and out back.
im in agony and dont know what to do, please help!
I honestly didn't not feel it much. I felt a slight inch when they put in the first injection, but the pinch was no worse than any other shot. I could feel him poking me, but nothing actually hurt. I was surprised when it was done because I hadn't really felt anything. The only thing that bothered me was the fact that the paper on my shoulder just covered my eyes so I couldn't see what he was doing. My arm is a little tense from the liquid being in there, but nothing hurts.
I have had X-rays , MRI , and attempted today to have a arthogram
Done however the doctor could not inject the contrast into the joint
She said she had done hundreds of them and have never been unable to do the test
She said a small amount may have gone in. He was using a ultrasound to guide her way between the joint
And could see the needle but it just wouldn't inject I could see her trying now my question is how can I proceed to get my repair done
23 years ago I had a torn rotator cuff and had it repaired if that helps with the reason why this test could not be done the constant dagger in my arm feeling
Is to much
I am 24 hours after hip MRI with dye, Horrible pain in my hip, plus fever start. Never again in my life!
So bad, what I didn't find this forum 48 hours ago.
That said, I've had more painful procedures done for less urgent things. If you're suffering from a chronic wrist injury, a few moments of pain is a small price to pay. Be prepared when you walk in for the injection- perhaps ask for a local anesthetic if you feel you need it- but I can tell you that even without it the worst of the pain only lasts a few seconds before it begins to taper off. Just grit your teeth and you're through it.
Reading through the comments, it seems like there's great variance in people's experiences, but those that got lidocaine seem to have fared well for the most part- and of course you're more likely to post about a bad experience than a good one. If you ask me, the bottom line should be ask questions, trust your doctor, and ask for a local!
would make me anxious. When I was given a local anesthetic, there was barely a pinch, the radiologist explained everything he was doing. I have had an analgesic/steroid injection in the
same hip previously which went very smoothly. I was hoping this would be the same. It felt like the needle was being pushed in further, I told the radiologist I could feel that, then I felt
the pressure of the contrast dye going in, more pressure then a sudden shooting pain like a bomb going off into my whole leg down to my knee. It felt like a huge cramp, throbbing!!
I cried out and asked if I could move my leg. The radiologist said he had to put in the rest of the dye (so that is why it hurt?) The nurse sitting at my side said that usually doesn't happen.
I did not see the radiologist again. I wasn't asked to turn my leg in any position for x rays like I had read on line. After moving my leg, crying!! then sitting up, the nurses assisted me into
a wheel chair and into MRI. There I told a technician about my experience and he said maybe the radiologist hit a nerve. Never read anything about that on line either. The MRI confin-
ment and all wasn't bad, I had ear plugs in and kept my eyes closed, laid very still hoping the pain didn't come back. I was not given any follow up instructions when I was done. Now
30 hours later, my hip, leg, knee and lover back are painful. Have maxed out on my pain meds. Not impressed. Have tried to sleep but have flash backs about that horrible leg pain and
keep waking up. Well hopefully they will find out what is wrong with my hip and all of this wasn't a waste of time.
When he injected the needle in my left hip all was fine I even looked at the monitor an began to calm when the doctor touched a spot that was sore and I shared this with him. He told me I was doing fine and it was almost over all of a sudden I started screaming and was in the most awful pain I have ever expierenced and something he was touching caused my back to cramp.
Has it helped, I am able to do a little more, have been experienced a little nausea , but I will never have it done again without some sort of medicine to put me out.
Was wonderful. I can.t believe some of the stories I have read.
Well, let me tell you how this appointment went today. I took nothing before the appointment for pain. Went there and let them know I do not do pain well. The doctor said as soon as there was any issues through this to let him know. The doc said he would walk me through each step as we came to it.
They prepped my shoulder from the front. Made me nervous I may see what's happening. Also, I saw the two needles before hand and they are LONG. As the doc got ready to put the first needle in, I looked away. The doc said it would be uncomfortable, have pressure and feel like being stung by a bee. I was uncomfortable, I won't lie. BUT I would not say it was painful. Keep in mind I do not do pain well. I think the worst part was how deep the needle was giving the bee sting sensation. This first needle was to numb me. I would say it had the same sensation as being numbed at the dentist. It sucks, has that bee sting sensation and once it's done it's done.
The doc took that needle out. At this point I again would say I am not in pain but my shoulder is very sore. The worst of the pain is truly over. Now comes a VERY long needle. I am having much anxiety. The doc explained the pain is caused not by how long the needle is but by how wide the needle is. The doc said he goes with the thinnest needle he can to help with this.
I again looked away. A machine is taking pictures so the doc can make sure he is lined up correctly. I continued watching the monitor not realizing until I saw it on the screen that the second needle was in me and the dye was being injected at that moment. I did NOT feel that at all. That took only a few moments. This whole procedure took maybe ten minutes tops. Once the doc took the second needle out it was done and I was ready for the Mri.
It is five hours later. I am very very sore. Not pain but sore. I have been taking it easy all afternoon. I also took ibuprofen 600 due to the discomfort. I feel like I have overly worked the shoulder and will probably have a bruise where the two needles went in. I always have shoulder pain so I think this procedure helped agitate it a bit but again it's just very sore.
I wanted to share my experience since reading everyone's else's freaked me out so bad. I promise I would warn if I had any pain. Maybe because my needle was so thin is what helped. Good luck to you reading this preparing for your upcoming procedure.
I was lucky to have an MD perform my procedure, I had a surprisingly pleasant experience I felt the pinch of the needle and then the "pop" sensation when they got through the joint capsule of the hip. It was a similar sensation to getting blood taken more intense but I was numb and after that i felt nothing beyond pressure. The pain from the test pales greatly in comparison of the pain I have suffered for YEARS. The MRI was like every other MRI I had before loud and hard to sit still but that's all. I had no pain that day, I felt discomfort the next day and it did cause aggravation to my existing issues. HOWEVER, this has proved to be very worth while for me. I wish I had followed doctors advise instead of reading what other people had experienced. I decided to share mine because i was terrified by what i read and found the hip Arthrogram to be extremely useful diagnostic tool. I wish I had done it sooner.
All what I can say to you is : I didn't felt anything at all during the Injections. . Lush
The part I am really struggling with is the post pain. i wasnâ€™t in too much pain prior to the procedure but It feels like i was in my car accident all over again from 2 years ago. Itâ€™s been achy and very heavy and I ended up having to leave work today. I was told nothing about the post pain or how long it would last and i am extremely frustrated...
It was WAY better than I thought! The lidocaine punches/burns for a second. Didn't feel second needle til it got to joint space-I shouted out but it was more surprise than pain. Didn't feel anything else. Still numb now, knee is swollen and heavy, but really don't overthink it it was not bad. Worst part for me was holding knee position because I can't straighten my knee.
it was pretty mild. the mri went well, but then again, I have had about 10 of them in my lifetime so I am used them. what concerns me is after reading the post-op care instructions, there was information regarding possible side effects so I googled some articles that elaborated on that subject. I came across a few articles stating that chuck noriss's wife supposedly got poisoned from the substance they use to create the contrast and they ended up suing for 10 million. based on that information alone, I would have thought twice about going through with it but I guess like anything else, including surgery, there is always a risk for complications. but as far as the procedure itself, it was not bad at all.
Well, it was a horrible burning and stinging followed by incredible pain, which caused my leg to spasm when the needle hit my knee joint. I was crying requested more anesthetic. The doctor injected more of the anesthetic and the pain subsided. After that all I felt was the pressure of the dye being injected.
Following the arthrogram, the doctor told me no swimming, hot tubs, or baths for several days. All night I had burning, stinging and sharp pains in and around my knee. Today, I took a Zertec antihistamine because my throat glands were painful and swollen. I have tingling around my jawline. My ears are ringing. My knee area fluctuates from feeling cold to hot and is still very painful. I am icing my knee and staying off of it as much as possible. I am hoping all of this will pass. Has anyone else experienced any of this after a knee arthrogram?
the pain was terrible for 2 minutes
after that the pain decreased
pain rate today is at 3 out of 10
don’t be scared
for me it doesn’t hurt more than the injured shoulder prior to the procedure