Arthrography (Joint X-ray)

What does the equipment look like?

You will be positioned on an examination table. Above you will be a box-like structure containing the x-ray tube and fluoroscopic equipment that will send the radiographic images to a screen monitor either in the examining room or in a separate room for the radiologist. Underneath the examination table is a special drawer that holds film in a cassette tray for development of still images.

Other equipment necessary for performing arthrography include a variety of large needles, syringes, water-soluble and colorless contrast material, sterile sponges and towels, a container to hold the removed joint fluid, and a sterile adhesive bandage.

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How is the procedure performed?

In the examination room, you are positioned on a table to examine the affected joint. Simple x-ray images of your joint are obtained to compare with the arthrograms.

Next, the skin around your joint is cleansed with antiseptic, and a local anesthetic may be injected into the area around the joint. A needle with an aspiration syringe is then inserted into the joint space. The radiologist will use the syringe to drain the joint fluid, which may be sent to a laboratory for analysis. Next, the aspirating syringe is replaced with one containing contrast material. If the fluoroscopic examination shows correct needle placement, the contrast material and air are injected into the joint space. After the injection, the needle is removed and the site is rubbed with a sterile sponge and may be sealed with collodion to prevent air from escaping. You will be asked to move the affected joint to more evenly distribute the contrast material. Still images are then obtained with the joint in various positions.

The examination is usually completed within 45 to 60 minutes.

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What will I experience during the procedure?

To many patients, the thought of having needles plunged into their joints seems particularly gruesome. But just as major dental work is done only after the administration of an anesthetic to numb the involved area, your joint area may be numbed so you do not feel anything related to the arthrographic procedure. Initially, you may experience a slight pinprick and momentary burning as the anesthesia is injected into the joint area. You may feel a fullness as the joint is filled and you may feel and hear gurgling when the joint is moved.

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Who interprets the results and how do I get them?

Most patients undergo arthrography because it has been recommended by their orthopedic surgeon or primary care physician, also called the referring physician. The images are interpreted by a radiologist, though not necessarily the one who was present during your examination. The interpretation is subsequently forwarded to your orthopedist or primary care physician. Depending on the interpretation, you and your physician will determine the next course of action, such as treatment for an abnormality, if necessary.

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What are the benefits vs. risks?

Benefits

Arthrography is particularly effective for detecting tears or lesions of the structures and ligaments of the joints, especially the knee, wrist and elbow, as well as rotator cuff tears or damage from a shoulder dislocation.

Risks

Patients who have known allergies to iodine may have an adverse reaction to the contrast material. Because the contrast material is put in a joint and not a vein, allergic reactions are rare, although, in some cases, mild nausea to severe cardiovascular complications may result.

Women should always inform their doctor or x-ray technologist if there is any possibility that they are pregnant.

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What are the limitations of Arthrography?

An improper injection technique may result in the contrast material being in the wrong location for optimal visualization of the joint. Also, if the joint fluid is not fully removed, it dilutes the contrast material and diminishes the quality of the image.

After the examination, vigorous exercise is not recommended for 12 hours.

You may experience swelling and discomfort or hear a crackling noise in the joint. You may apply ice to the joint to reduce swelling if it is bothersome. A mild over-the-counter analgesic can be taken for pain. These symptoms usually disappear after 48 hours. Contact your doctor if they persist after two days.

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To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database.

This procedure is reviewed by a physician with expertise in the area presented and is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise in several radiologic areas.