Arthrogram in layman’s language can be described as X-ray of joints that produces multiple pictures. The procedure is different than ordinary X-ray as arthrogram requires injection of a contrast material like dye. Anatomical structure of the joint that comprises of ligaments, tendons, cartilage, muscles and joint capsule are captured clearly on paper by arthrogram which normal X-ray is unable to do. The series of pictures thus obtained are used by orthopedics to diagnose joint disorders and decide treatment approach. Sometimes, arthrogram can be used in combination with MRI or CT if arthrogram pictures provide inadequate information. Arthrogram can be carried out on various joints, such as knee joint, shoulder joint, ankle joint, elbow joint, jaw and wrist joint.
Let’s understand arthrogram in detail.
Why is arthrogram performed?
Arthrogram is carried out for various reasons. One of the prime reasons is to diagnose inexplicit reason for joint pain or swelling. By looking at reports of arthrogram, doctors are also able to understand the reason for abnormal movement of joint. The following points will throw light on why arthrogram is needed:
- To diagnose abnormalities in joint components like tendons, ligaments, joint capsule, cartilage and muscles. It is especially helpful in diagnosing problems of rotator cuff located in shoulder joint.
- To detect cysts or abnormal growths
- To confirm correct placement of needle prior to the commencement of joint fluid analysis procedure. This procedure draws out sample of fluid in the joint through the needle.
- Also used prior to painkilling injection like corticosteroid injection to access correct position of needle
Arthrogram procedure:
When the doctor discusses with you about the need of an arthrogram, it is important that you notify him about your health status and allergic conditions. Let the doctor know if you are allergic towards iodine as it is a constituent of many contrast materials. Accordingly doctor will do some allergy tests. If you are on blood thinning medicines or pregnant or have infection in the joint on which arthrogram is to be performed, then it is better that the doctor knows about all these things. Give a brief idea about your current health status and diseases you are suffering from. If you have any doubts about the procedure, you can straight away get them cleared.
Arthrogram is usually performed by radiologists. Patient is required to remove all metallic jewelry or metallic objects from the joint area which is to be exposed. You will be made to either sit or lie down under a fluoroscope that is attached to video screen on which X-ray images are displayed. Before local anesthesia is administered to numb the joint, nurse will clean the skin covering the joint with an antiseptic liquid or soap.
Needle is now injected in the joint to inject contrast material. Fluoroscope reveals whether the needle is correctly placed or not. Once, the needle is in right position, dye or air is injected through it into the joint. If need arises, both dye and air can be injected, which is called as double contrast arthrogram. Once, the required amount of dye is injected, the needle is removed. In rare circumstances, joint fluid may be removed if there is a need to administer more of contrast dye. This joint fluid is examined under the microscope to check for presence of abnormalities. In order to enable easy movement of fluid, radiologist will ask you to move the joint. Picture of dye covering the entire joint can be obtained through fluoroscope. When X-rays are to be taken, patient is advised to keep the joint as still as possible unless the radiologist tells you to do so. The radiologist takes pictures from various angles. These pictures are then analyzed to generate report.
Once the procedure is over, patient is required to drink lots of water to eliminate contrast material from the body. Some patients might experience soreness which will fade away within a day or two. If soreness persist, better get it checked by your doctor.
What are the types of arthrogram imagery?
Arthrogram imagery can be divided into four types – X-ray, fluoroscopy, computer tomography (CT-Scan) and magnetic resonance imaging (MRI-Scan). Doctor may employ normal arthrogram with CT-Scan or MRI-Scan to get more elaborate information about internal structure of your joint.
- In Fluoroscopy, iodine containing dye is injected into the joint. The dye is given time to fill up the entire joint and then observed under fluoroscope. The picture helps radiologist to access the joint and figure out abnormalities.
- MRI makes use of gadolinium dye that affects local magnetic field inside the joint and provide clear outline of the structure of the joint. Factors such as powerful magnetic fields, radio frequency pulses and a computer are used to map out an elaborate picture of the internal structure of the joint.
- A CT arthrography makes use of X-rays to create cross-sectional images of the joint and are processed by a computer. The procedure also makes use of conventional dyes and sometimes supplemented or combined with air to produce a double-contrast arthrogram.
What are the possible complications of arthrogram?
Arthrogram is a safe procedure and there are hardly any risks or complications involved. The only risk it carries is that of infection. Infection might happen due to transfer of micro-organisms from patient’s skin to the joint. That is the reason why the skin of the joint is thoroughly washed with antiseptic liquid or with soap before arthrogram is carried out. This reduces chances of infection.
If infection is already present on the skin overlying the joint, then arthrogram procedure is postponed till the skin gets completely healed and is normal. Another possibility of complication can arise from allergic reaction towards contrast material used. If the person suffers from an allergy towards contrast material, then some allergic reaction may happen in the form of rash. Serious allergic reactions are rare.
How long does arthrogram take?
It takes approximately 15 minutes for arthrogram procedure. The patient is required to wait for sometime after contrast material has been injected. Once, fluoroscope shows that the dye has spread out well in the joint, then the scan is carried out. Pictures of the joint are then taken. In all, it takes around 2 hours for the complete procedure of arthrogram to complete and that includes waiting time after the injection of contrast dye.
Who does the arthrogram?
Arthrogram is generally performed by trained radiologists who inject contrast dye into the joint, perform scans and analyse the findings to generate a formal report. Based on this report, orthopedists are able to diagnose joint problem. To assist radiologists, either a nurse or radiographer may be present. Radiographer will be involved in taking pictures and subsequent scan under the direction of radiologist.
What are the benefits of arthrogram?
Arthrogram is more beneficial in diagnosing joint disorders than normal joint X-rays because of precision or clarity of images produced by it. The images are able to depict internal structure of the joint like softer muscles, tendons, ligaments, cartilages and joint capsule quite well. This enables the orthopedist to find faults or abnormalities in the joint and therefore diagnose the disorder. Hence, in most of the situations of joint problems, your orthopedist may ask you to undergo arthrogram in order to gain more information about it so that you can take care of your joints in proper way. Following are the reasons why arthrogram proves beneficial on following joints:
- Shoulder Joint: Arthrogram reveals where the joint is unstable or when MRI or ultrasound fails to show suspected tendon tear
- Wrist Joint: Arthrogram helps in revealing any tear in small ligaments of the wrist joint
- Hip Joint: Arthrogram shows if there is any tear in cartilage labrum (or rim of the joint)
To conclude, arthrogram is a safe procedure which makes use of contrast material to get elaborate pictures of internal structures of joint. The orthopedist then makes use of these pictures to diagnose joint disorders and decide treatment approach. The pictures help in understanding how much part of the joint is damaged, whether there is any tear and how quickly treatment should commence in order to curb and heal the damage caused. If you have any doubt regarding the procedure, ask your doctor right away.