Arthrography
Arthrography is the radiographic examination of a joint after the injection of a
dye-like contrast material and/or air to outline the soft tissue and joint structures on
the images.
Uses of Arthrography
Arthrography is done most commonly to identify abnormalities associated with the
shoulder, wrist, hip, knee and ankle. Patients who undergo this procedure usually have
complained of persistent, unexplained joint pain or discomfort. Arthrographic images may
allow identification of problems with a joint's function or indicate a need for a joint
replacement.
Before having Arthrography
Patients who are pregnant or may be pregnant should not have this procedure unless the
benefits of the findings outweigh the risk of radiation exposure. Patients who are known
to be allergic to iodine need to discuss this complication with their physician. Patients
who have a known allergy to shellfish are more likely to be allergic to iodine contrast.
Description of Arthrography
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 move the joint around 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.
Preparation for Arthrography
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 extend from only 90 minutes prior to the exam up to the night before. There
is no other preparation necessary.
Aftercare of Arthrography
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 of Arthrography
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 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.
Abnormal results of Arthrography
The abnormal placement of dye may indicate rheumatoid arthritis, cysts, joint
dislocation, rupture 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. |
