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Arthrography is a sterile procedure used for examining various bony joints. It involves introduction of contrast or dye-like material into the joint being studied. The contrast material distends the joint capsule, outlines small structures within the joint (such as labrum in the shoulder or hip, ligaments and tendons in all joints) and fills any abnormally formed spaces such as tears. Some of the normal structures or abnormal processes within the joints may be too small to be visualized on routine MRI but become considerably better seen by the radiologist after arthrography is performed. Joints most commonly evaluated with arthrography are the shoulder, wrist, hip and elbow. Arthrography is also sometimes performed in the knee and ankle.
When is arthrography performed?
In patients who have not had prior joint replacement surgery, arthrography is often performed immediately prior to an MR scan to increase the diagnostic sensitivity of the MR examination. In patients who have joint prostheses (such as hip, knee or shoulder replacement), arthrography can be performed to evaluate the hardware for any evidence of failure, without subsequent MR examination. For patients who have had certain types of shoulder or knee surgery, arthrography is sometimes followed by a CT scan.
What can I expect during the procedure?
After you are positioned on the X-ray table, the skin around your joint is cleaned with an antiseptic solution. Local anesthetic is administered into the skin to minimize any discomfort. Using fluoroscopy the radiologist then guides a needle through the skin into the joint capsule. The correct needle placement is confirmed by injecting a small amount of contrast material. If the position is appropriate, a larger volume of contrast material is injected into the joint capsule. Gadolinium is the most commonly used contrast material in patients who have arthrography prior to an MR examination. In other patients, Omnipaque or another type of iodinated contrast may be used. After the contrast is injected, the needle is removed and the skin is cleansed again with alcohol. The radiologist may then take several X-ray images (arthrograms) of the joint.
How long will the exam take?
Arthrography usually takes between 15 and 30 minutes. More complicated cases may take longer.
Will it hurt?
There is usually no major discomfort associated with arthrography. You may feel a pinprick-like sensation and burning when local anesthetic is injected into the skin (similar to the sensation experienced during dental procedures). After the skin becomes numb,
patients usually feel no sharp pain, only pressure from the advancing needle and fullness from the injected contrast. Occasionally, a transient sharp sensation may be experienced very briefly as the needle goes through the joint capsule.
Complications associated with arthrography are exceedingly rare. Use of antiseptic solution all but eliminates the risk of infection, which is about 1 percent. Other potential complications include bleeding (if it occurs, it is usually minor and
self-limiting) and possible allergic reaction to contrast material.
Patients who have known history of allergies to contrast material or who may be pregnant should inform the radiologist or technologist about their condition prior to the procedure.
