Arthrogram - Types, Uses, Procedure, Benefits, and Complications

What Is an Arthrogram?

An arthrogram is a diagnostic imaging procedure used to evaluate and diagnose unexplained pain and other problems related to the joints, tendons, ligaments, or cartilages. It is also called arthrography. This procedure helps to assess the joint structure and functions in-depth. In this procedure, a contrast medium is usually injected into the joint, and X-ray images are taken. MRI or CT may also be used if needed.

What Are the Types of Arthrogram?

There are two types of arthrography: (1) Direct and (2) Indirect:

1. Direct:

• In this procedure, thin needles are used to inject the contrast material directly into the joint.

• This is the most preferred technique as the joint tends to distend and enlarge, thus resulting in better visualization and improved evaluation of the conditions.

2. Indirect:

• The contrast material is injected into a vein near the joint; it reaches the joint through the blood vessels, where it is absorbed into the joint tissues.

What Are the Uses of Arthrogram?

• An arthrogram is usually performed in joints with unexplained pain, discomfort, or reduced mobility.

• It is usually done on joints such as the shoulder, hip, elbow, ankle, knee, and wrist.

• It is used to detect any tear in ligaments, tendons, or cartilages.

• To check for damages due to repeated dislocation.

• It is also used to inject steroids into the joint. This procedure is known as therapeutic arthrography.

• Used to detect abnormal growth or synovial cysts.

• It is also routinely carried out before surgical procedures such as joint replacement.

What Are the Patient Instructions Before the Procedure?

• This procedure does not require any particular preparations.

• No dietary restrictions are required unless sedation has to be used for MRI arthrography.

• Patients should wear loose and comfortable clothing.

• They should remove all jewelry, valuables, removable dental appliances, and any metallic objects like a key or wallets before the procedure.

• Patients should inform the doctor of all the prescription medicines, especially blood-thinning medicines taken by them. The anticoagulants may need to be stopped, or the dose may have to be adjusted before the procedure.

• Any history of allergy should be informed by the patient.

• Patients with kidney diseases should inform their medical history to the doctor, as complications may arise from the contrast material used in MRI arthrography.

• Patients with claustrophobia may require sedation before the procedure.

• Patients should inform the doctor if they have any medical or electronic devices within their body, such as cochlear implants, cardiac defibrillators, or pacemakers, as they could interfere with the MRI examination and pose a great risk.

• Patients are advised to carry all their medical reports while coming for the arthroscopy procedure.

How Is the Procedure Done?

• It is usually done as an outpatient procedure. The patient will be advised to change into a hospital gown and will be made to lie on the examination table.

• A baseline X-ray is usually taken before the procedure to compare it with images after arthroscopy.

• The examination area is covered using sterile drapes and cleaned using an antiseptic solution.

• The local anesthetic will be injected using a small needle to numb the area around the joint. The patient might experience a mild burning sensation when the local anesthetic is injected.

• If an infection is suspected, the radiologist may aspirate the fluid from the joint and send it for laboratory investigation.

• Once the joint area is numb, the radiologist, with the help of a fluoroscope or an ultrasound, may inject the contrast material into the joint. A long thin needle will be used for the same.

• For the dye to be evenly distributed throughout the joint, patients are advised to move the joint.

• The use of contrast medium depends on the imaging modality. An iodinated contrast medium is used for X-ray arthroscopy, air on its own or mixed with small quantities of X-ray contrast medium is used in CT arthrogram, and gadolinium-based contrast material is used in MRI arthrogram.

• After removing the needle, the injection site will be cleaned.

• The images of the joint will be taken either by using an X-ray, CT, or MRI.

• During the procedure, the radiologist may also inject corticosteroids so that the inflammation is reduced, which will enable better visualization of the structures.

• The arthrogram procedure may take roughly from 30 minutes to an hour. An MRI arthrogram may take even longer.

• A bandage and a sterile dressing will be applied over it.

What Instructions Should Be Followed After the Procedure?

• Patients would be advised to resume their normal diet and activities if no sedation was given.

• Patients are advised to rest the joint for a few hours after the procedure.

• A sore joint is normal after the procedure. It can last for a day or 2. Patients will be advised to take analgesics and antibiotics to counter any infection.

• Ice application will help to reduce the swelling around the joint.

• Clicking and cracking noises are normal in the joint and should resolve within two days.

• Patients are advised to avoid lifting heavy weights and intense exercise for a few days.

What Are the Benefits of the Procedure?

• Very effective in detecting problems associated with the joints such as ligaments, tendons, and cartilages where an ordinary X-ray may not be beneficial.

• The procedure is not painful. Patients usually just have a feeling of fullness or tightness near the joint.

• Minimally invasive.

• The radiation used is minimal, and no radiation stays in the body.

What Are the Complications Associated?

• Allergic reactions to the dye may occur; however, the chances are extremely low as the dye does not enter the blood circulation.

• Chances of radiation exposure.

• Chances of infection and bleeding.

• Risk of injury to adjacent vessels or nerves.

• Gadolinium contrast used in MRI arthrography can cause nephrogenic systemic fibrosis in severe kidney patients.

When to Seek Medical Advice?

You need to contact your doctor if you have the following conditions after the procedure:

• Fever.

• Increasing pain around the injection site.

• Redness or bleeding at the site of injection.

• Swelling that lasts for more than two days.

• Unexplained drainage from the injection site.

What Are the Limitations of the Procedure?

• Contraindicated in pregnancy and lactating mothers.

• Not advised in patients with active arthritis or joint infections.

• Contraindicated in patients with bleeding disorders.

• It cannot be used in conditions where MRI and CT are contraindicated.

Conclusion:

Joint pain can be a major deterrent to a healthy and active social life. Diagnosing any joint pain is a very intricate and complex process. However, early diagnosis and prompt treatment can help patients lead pain-free lives. Arthroscopy is a relatively simple and painless procedure that could help patients with proper treatment and thus improve their quality of life.