Arthrography (Joint X-ray)
What is Arthrography? Back to Top
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.
What are some common uses of Arthrography? Back to Top
Arthrography
is done most often 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.
How should I prepare for the procedure? Back to Top
No special preparation is necessary before arthrography. Food and fluid intake do not need to be restricted.
A
nurse or radiologic technologist may ask you to change into a gown with
no metal fasteners that can show up on the images. If necessary, you
may also have to remove some of your jewelry if it will interfere with
the procedure.
What does the equipment look like? Back to Top
You
will be positioned on an examination table. Above you will be a
box-like structure containing the x-ray tube and fluoroscopic equipment
that will send the radiographic images to a screen monitor either in
the examining room or in a separate room for the radiologist.
Underneath the examination table is a special drawer that holds film in
a cassette tray for development of still images.
Other
equipment necessary for performing arthrography include a variety of
large needles, syringes, water-soluble and colorless contrast material,
sterile sponges and towels, a container to hold the removed joint fluid
and a sterile adhesive bandage.
How does the procedure work? Back to Top
Joint
fluid is removed and replaced with injected contrast material or
air—sometimes both. A series of radiographs, sometimes called
"arthrograms," are obtained before the joint tissue absorbs the
contrast material. Occasionally, the examiner will take additional
x-rays as he or she pushes and pulls on your joint.
How is the procedure performed? Back to Top
In
the examination room, you are positioned on a table to examine the
affected joint. Simple x-ray images of your joint are obtained to
compare with the arthrograms.
Next, the skin around your joint
is cleansed with antiseptic and a local anesthetic may be injected into
the area around the joint. A needle with an aspiration syringe is then
inserted into the joint space. The radiologist will use the syringe to
drain the joint fluid, which may be sent to a laboratory for analysis.
Next, the aspirating syringe is replaced with one containing contrast
material. If the fluoroscopic examination shows correct needle
placement, the contrast material and air are injected into the joint
space. After the injection, the needle is removed and the site is
rubbed with a sterile sponge and may be sealed with collodion to
prevent air from escaping. You will be asked to move the affected joint
to more evenly distribute the contrast material. Still images are then
obtained with the joint in various positions.
The examination is usually completed within 45 to 60 minutes.
What will I experience during the procedure? Back to Top
To
many patients, the thought of having needles plunged into their joints
seems particularly gruesome. But just as major dental work is done only
after the administration of an anesthetic to numb the involved area,
your joint area may be numbed so you do not feel anything related to
the arthrographic procedure. Initially, you may experience a slight
pinprick and momentary burning as the anesthesia is injected into the
joint area. You may feel a fullness as the joint is filled and you may
feel and hear gurgling when the joint is moved.
Who interprets the results and how do I get them? Back to Top
Most
patients undergo arthrography because it has been recommended by their
orthopedic surgeon or primary care physician, also called the referring
physician. The images are interpreted by a radiologist, though not
necessarily the one who was present during your examination. The
interpretation is subsequently forwarded to your orthopedist or primary
care physician. Depending on the interpretation, you and your physician
will determine the next course of action, such as treatment for an
abnormality, if necessary.
What are the benefits vs. risks? Back to Top
Benefits
- Arthrography is particularly effective for detecting
tears or lesions of the structures and ligaments of the joints,
especially the knee, wrist and elbow, as well as rotator cuff tears or
damage from a shoulder dislocation.
Risks
- Patients who have known allergies to iodine may have an
adverse reaction to the contrast material. Because the contrast
material is put in a joint and not a vein, allergic reactions are rare,
although in some cases, mild nausea to severe cardiovascular
complications may result.
- Women should always inform their doctor or x-ray technologist if there is any possibility that they are pregnant.
What are the limitations of Arthrography? Back to Top
An
improper injection technique may result in the contrast material being
in the wrong location for optimal visualization of the joint. Also, if
the joint fluid is not fully removed, it dilutes the contrast material
and diminishes the quality of the image.
After the examination, vigorous exercise is not recommended for 12 hours.
You
may experience swelling and discomfort or hear a crackling noise in the
joint. You may apply ice to the joint to reduce swelling if it is
bothersome. A mild over-the-counter analgesic can be taken for pain.
These symptoms usually disappear after 48 hours. Contact your doctor if
they persist after two days. Back to Top |
