What is arthrography?

Arthrography is a type of imaging test used to look at a joint, such as the shoulder, knee, or hip. It may be done if standard X-rays don't show the needed details of the joint structure and function.

In arthrography, a long, thin needle is used to put contrast dye right into the joint. Then a series of X-rays is taken with the joint in various positions. X-rays use small amounts of radiation to get pictures of the inside of the body. Sometimes air is used as the contrast substance when regular contrast can't be used.

An arthrogram may also use fluoroscopy, CT, or MRI instead of X-rays to get better pictures of the joint.

Arthrography is most commonly used to examine the knee and shoulder joints. It may also be used to look at other joints, such as the wrist, ankle, hip, or elbow.

Why might I need arthrography?

Arthrography may be done on a joint when there has been persistent and unexplained pain, discomfort, or loss of motion. Or changes in the way the joint works. Other reasons to do this test may include:

• To find problems, such as tears in the soft tissues of the joint. These tissues include ligaments, tendons, cartilage, and joint capsules.

• To check for damage from repeated dislocations of the joint

• To check prosthetic joints

• To look for synovial or cartilage problems

• To look for an abnormal pathway called a sinus tract that may form after infection

• To look for loose bodies

There may be other reasons for your healthcare provider to recommend arthrography.

What are the risks of arthrography?

You may want to ask your healthcare provider about the amount of radiation used during the procedure. Also ask the risks related to your situation. It's a good idea to keep a record of your radiation exposure. This includes previous CT scans and other types of X-rays. This way you can inform your healthcare provider. Risks linked with radiation exposure may be related to the cumulative number of X-ray exams, treatments over a long period, or both.

Tell your healthcare provider if you are allergic or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex.

Some potential risks of arthrography include:

• Infection and bleeding at the needle site where the contrast dye is injected

• Allergic reaction to the contrast dye. This is rare with direct arthrography because the dye is not injected into a vein

Arthrography is not recommended for people with active arthritis or joint infections.

Tell your healthcare provider if you are pregnant or think you may be. Radiation exposure during pregnancy may lead to birth defects. Special precautions will be taken to reduce the radiation exposure to the fetus if you must have an arthrography exam.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for arthrography?

• Your healthcare provider will explain the procedure to you and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• There is no special restriction on diet or activity before arthrography.

• Be sure to tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, anesthetic agents (local and general), contrast dyes, or iodine.

• Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders. Or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

• If you are pregnant or think you may be, tell your healthcare provider.

• Your healthcare provider may give you other instructions on what to do before the procedure based on your medical condition.

What happens during arthrography?

Arthrography may be done on an outpatient basis or as part of your stay in the hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, arthrography follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that might get in the way. A bracelet with your name and an identification number may be put on your wrist. You may get a second bracelet if you have allergies.

2. When you are asked to remove your clothing, you will be given a gown to wear.

3. You will be positioned on an exam table in the procedure room.

4. X-rays of the joint may be taken before the injection of the contrast dye for comparison with the pictures taken after the dye is injected.

5. The skin around the joint will be covered with sterile drapes and cleaned with an antiseptic solution.

6. The area around the joint will be numbed by using a small needle to inject a local anesthetic (numbing medicine). You may feel burning before you feel a numbing sensation.

7. If there is fluid in the joint, this fluid will be removed with a longer needle and syringe.

8. The contrast dye will be injected into the joint using a long, thin needle. You may feel pressure as the needle is moved into the joint. Tell the healthcare provider if it hurts so more numbing medicine can be used. After this injection, you may be asked to move the joint so that the dye moves evenly throughout the joint. You may be asked to exercise the joint.

9. Once the contrast dye has moved through the joint, multiple X-rays will be taken with the joint in various positions. In some cases, a special frame or traction may be used to stretch the joint for a wider view of the joint. Things like pillows or sandbags may be used to help position the joint. In most cases, you will get an MRI, or less commonly, a CT, after the arthrogram has been done.

The arthrography procedure itself usually causes minor pain. But having to move or hold the joint still in certain positions might cause some additional discomfort or pain. This is true if you’ve recently had surgery or a joint injury. The technologist will use all possible comfort measures and complete the procedure as quickly as possible to reduce any discomfort or pain.

What happens after arthrography?

Your healthcare provider will give you specific instructions regarding movement of the joint, pain medicine care of the affected joint, symptoms to watch for, and any activity restrictions.

You may be asked to rest the joint for several hours right after the procedure.

Some mild swelling and fullness may be noted in or around the joint. Your healthcare provider may suggest that you apply ice if swelling happens. Contact the healthcare provider if swelling continues or increases after a day or two.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

The affected knee may be wrapped with an elastic bandage for several days after a knee arthrogram. You will be shown how to apply the bandage and remove it for bathing and dressing.

You may notice some clicking or cracking noises with movement of the joint for a few days after the procedure. This is normal. It should resolve within a few days.

Tell your healthcare provider if you have any of the following:

• Fever

• Redness, swelling, bleeding, or other drainage from the injection site

• Increased pain around the injection site

You may resume your normal diet unless your healthcare provider tells you differently.

Your healthcare provider may give you other instructions after the procedure. This depends on your particular situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure