The use of iodinated contrast, computed tomography, and magnetic resonance imaging naturally came after this time. At this time, magnetic resonance imaging (MRI) is the first-line imaging modality for assessing joints as it has a superior soft-tissue contrast capability. In a patient who is claustrophobic or has any contraindications to undergo an MRI, a computed tomography (CT) arthrogram is a suitable option. Postoperative joints can lead to artifacts for which CT is a good option. Arthrography remains a useful imaging modality with computed tomography, CT scan, and magnetic resonance imaging, MRI, to allow a detailed assessment of articular structures of interest.
Glenohumeral arthrography, shoulder arthrography, is an imaging technique used in evaluating the glenohumeral joint and associated components. During an arthrogram, a joint injection is done typically under fluoroscopic guidance, but ultrasound or CT can be utilized. The process of a direct arthrogram leads to joint distention and separation of the intra-articular structures. This capsular distention allows for the enhancement and visualization of small joint bodies, the labrum, glenohumeral ligaments, rotator cuff undersurface, the structures of the rotator interval, and the long head of the biceps. Direct arthrography in which contrast is injected into the joint has an alternative procedure termed an indirect arthrogram. An indirect arthrogram is a technique that produces arthrographic images without utilizing direct joint injection.
Generally, radiographic examinations demonstrate soft tissues like cartilage, muscle, joint fluid, and menisci to be of the same density. Therefore, these structures are not distinguishable from one another. The term arthrography refers to an imaging modality following the injection of contrast into a specific joint, typically performed with fluoroscopic guidance. Utilizing injected contrast outlines the intraarticular structures and differentiates them from other adjacent soft tissues. The injection also allows for distention of the joint, providing better visualizations and separation of structures. During an arthrogram, a sterile technique and local anesthetic are utilized. A needle is introduced into the joint space where synovial fluid can be aspirated if needed for any diagnostic purpose. Contrast like iodinated contrast is injected into the joint.
Additional medication like an anesthetic or a glucocorticoid can also be injected into the joint space for therapeutic purposes during the arthrogram. The arthrogram can aid in facilitating the identification of ligamentous or tendon injuries, intraarticular "loose" bodies, cartilage or synovial abnormalities, loosening of the joint prosthesis, and sinus tracts. The implementation of fluoroscopy allows for real-time tracking of contrast, which will pass into and fill the joint. The contrast pattern can highlight abnormalities like abnormal contrast leakage or synovitis. The arthrogram can be followed with computed tomography or magnetic resonance imaging. Rotator cuff tears and the labrum are more appreciated when there is delineation by contrast.
Glenohumeral instability is common and can be a perplexing clinical issue where both an accurate and a non-operative method of diagnosis is desirable. Shoulder arthrograms can serve as a useful aid in diagnosis. The glenohumeral joint is susceptible to instability and dislocation due to a combination of the bony discrepancy between the humeral head and the glenoid. This discrepancy allows for a larger range of motion. The biomechanics within the shoulder joint is based upon the interaction of both static and dynamic stabilizing systems. The static structures of the joint include the glenoid, glenoid labrum, humeral head, and capsule. The capsule includes the glenohumeral ligaments. The dynamic stabilizing structures include the rotator cuff and muscular structures surrounding the joint. When evaluating for shoulder pathology, it is crucial to remember the relevance of radiographs to assess osseous and joint structure abnormalities. Typically, an MRI study after conventional radiographs have been evaluated is performed.
In a patient with atraumatic shoulder pain with suspected adhesive capsulitis, the diagnosis is mainly based on clinical findings. Adhesive capsulitis, also known as frozen shoulder, is due to the contraction and thickening of the glenohumeral joint capsule and synovium. This process results in a progressive limitation in the joint's mobility with associated significant pain. Conventional arthrography is the imaging modality of choice for both diagnosis and treatment. There is a decreased capacity for injecting contrast into the joint, which is diagnostic for adhesive capsulitis in these cases. The distention of the capsule during the arthrogram can serve as a therapeutic tool.
Methods: All patients referred to our shoulder clinic over a ten-year period, between 2008 and 2018, with a clinical diagnosis of capsulitis and symptoms persisting for more than six months, were offered treatment with a distension arthrogram. All procedures were performed by one of five musculoskeletal radiologists, with a combination of steroid, local anaesthetic, and a distention volume of 10 ml, 30 ml, or 50 ml. Patient demographics, procedural details, recurrence of symptoms, and the need for further intervention were evaluated.
Results: A total of 2,432 distension arthrograms were performed during the study period. The mean time between arthrography and analysis was 5.4 years (SD 4.4; 1 to 11). Recurrent symptoms occurred in 184 cases (7.6%), all of whom had a repeat distension arthrogram at a median of nine months (interquartile range (IQR) 6.0 to 15.3). The requirement for further intervention for persistent symptoms following arthrography was significantly associated with diabetes (p
Intraoperative arthrograms are commonly used in conjunction with closed reduction and percutaneous pinning (CRPP) of pediatric lateral condyle fractures of the humerus. The authors sought to determine how arthrograms affect management of these fractures. They reviewed all lateral condyle fractures treated surgically at a pediatric level I trauma center from 2008 to 2014. They stratified patients managed with and without an arthrogram as well as by timing of arthrogram. The authors compared injury parameters, initial and postoperative fracture displacement, and complications between groups. They identified 107 patients who were taken to the operating room for attempted closed reduction, which they classified as either CRPP without arthrogram or arthrogram first and then a decision to treat open or with CRPP. Fifty-eight (54.21%) underwent CRPP without arthrogram and 49 (45.79%) underwent arthrogram. Of those who had arthrograms, 27 (25.23%) were prior to fixation and 22 (20.56%) were after fixation. There was no difference in age, weight, or preoperative displacement among the groups. Mean postoperative displacement was significantly lower in the no arthrogram group vs the arthrogram group (0.91 mm vs 1.68 mm; P
Arthrographic images help doctors evaluate the structure of a joint along with its function to determine if there is a need for treatment. Your doctor may prescribe an arthrogram as part of their diagnosis of the soft tissue structures inside your shoulder, hip, knee or another joint. Some of the main reasons to do this test include:
Knee and other joint arthrograms are used to help your doctor evaluate the structures and function of a particular joint. If they view any alterations to the joint, this procedure helps them determine the best form of treatment for your condition.
In some cases, arthrogram procedures have a therapeutic use. Arthrograms can be used to correctly position a needle within a joint so that medication or an anesthetic can be injected to decrease joint-related pain or inflammation.
What to expectAn arthrogram lasts about 20-30 minutes. Sometimes, arthrography may take longer depending on the imaging needed for a study. Before the procedure begins, your skin is cleansed with antiseptic soap and numbed with local anesthetic. Then, an interventional radiologist injects contrast into the joint. The contrast may make your joint feel full, but it is not usually painful. Following the injection, several x-ray images will be made.
After your arthrogram, your joint pain may worsen for the next 2-3 days. You may resume your normal medication, including pain medication, after your procedure. Rest and cold compresses are sometimes helpful to reduce any increased joint pain. One of our board-certified interventional radiologists will review the images and send a report to your physician.
During an arthrogram, we give your child a shot of fluid called contrast into the joint, which helps us see damaged soft tissue or cartilage. Then we perform the MRI test using magnets to produce detailed images of the joint.
Arthrography is the x-ray examination of a joint that uses a special form of x-ray called fluoroscopy and a contrast material containing iodine. A needle is placed into the joint for the arthrogram and contrast and/or medication are put into the joint after taking out any fluid from the joint.
An arthrogram (or arthrography) is a commonly performed procedure in musculoskeletal radiology, which can refer to both an injection into a joint, and cross-sectional imaging after a joint is injected. 041b061a72