• What is contrast arthrography?

Radiographic examination of soft tissue structures of joints after injection of contrast media

• MRI has largely replaced contrast arthrography– Noninvasive – fewer risks are associated

Contrast Media

• Air– Negative

contrast

• Iodinated contrast– Positive contrast

• Knee

• Hip

• Shoulder

• Wrist

• TMJ

Most common joints investigated using contrast arthrography

Knee

Procedure Indications:

• Cartilage, capsular injuries• Ligament or menisci injuries• Loose bodies• Joint rupture• Baker’s cyst• Synovial disease• Prosthesis check

Contraindications (Applies to all arthrograms)

• Skin infections

• Bleeding tendency

• Anti-coagulent therapy

• Allergy to contrast

Procedure

• Skin is first cleaned with betadine

• Local anesthetic is introduced

• Joint is punctured with needle

• (synovial fluid may be aspirated and sent for analysis)

Procedure cont’d

• Contrast introduced through needle under fluoroscopic guidance

• Needle is removed

• Pt asked to exercise knee to distribute contrast

• Pt is then turned prone if vertical method is used

• Spot radiographs are obtained by Radiologist

• Overheads

Vertical ray method

Beam shoots down (or up if using fluoroscopy)

Limb placed in stress device to widen side of jt space under investigation

Horizontal ray method

To demonstrate lateral and medial meniscus

Same procedure as with Vertical method but with crosstable CR (fluor not possible)

Tear in medial meniscus

Normal

Hip Arthrography

• Acetabular region of pelvis

• What kind of joint is hip?

– Diarthrotic- ball and socket joint

– Allows flexion, extension, abduction, adduction, rotation

Hip Arthrography cont’d

• Most often performed on children to evaluate hip dislocation before treatment

• In adults, primarily to check prosthesis dislocation or presence of infection

• Common puncture site:

– ¾ distal to inguinal crease and ¾ lateral to palpated femoral pulse

Radiographs

• AP

• Internal and external rotations

• Frog lateral

TMJ Arthrography CT and MRI have largely

replaced

Indications for Arthrogram of TMJ

Diagnosing abnormalities of articular disk

Subluxation (Incomplete or partial dislocation of bone in joint)

Aplasia- (defective development)

Fx.

Ankylosis- (stiffness of jt)

Arthritis

TMJ Arthrography

Procedure:

• Contrast injected ½ anterior to tragus of ear

• Fluoroscopy used to observe and image mandibular motion

• Radiographs made with pt’s mouth closed, partially open, and fully open

Shoulder Arthrography

Indications:

• Rotator cuff or long head of biceps tears

• Foreign bodies• Persistent pain or weakness• Frozen shoulder

After injection, take standard shoulder projections

CT often used in conjunction with shoulder arthrograms

Shoulder Arthrograpy

Rotator Cuff TearNormal

Wrist Arthrography

• IndicationsTraumaPersistent painLimitation of motion

• ProcedureContrast injected into dorsal wristWrist manipulated to disperse contrastRoutine images