ARTHROGRAMS RT 255 2005

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ARTHROGRAMSRT 255 - 2005

• Radiography of a joint space or its surrounding
  structures with injection of contrast media

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ARTHROGRAMS

• Injected into JOINT SPACES
• DOUBLE CONTRAST
• IODINE (positive contrast)
• WATER soluble
• (Ionic or Non-Ionic)
• AIR (negaitve contrast)

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Arthrography is concerned with synovial joints

• MOSTLY REPLACED BY MRI
• non invasive,
• good detail of soft tissue structures
• CONTRAINDICATIONS TO MRI
• CLAUSTROPHOBIC
• PT SIZE
• Foreign Body (metal)
• COST / INSURANCE REIMBURSEMENT

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INDICATIONS FOR EXAM

• This procedure is used to obtain diagnostic
  information regarding the joints and surrounding
  soft tissues or cartilage.
• ligament, meniscus (cartilage), bursa
• Usually done for the knee
• shoulder, hip, wrist, TMJ

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Contrast media

• Contrast INJECTED into joint space capsular
  space bursa (30 100 ml may be needed)
• CONTRAST water based only iodinated (ionic
  or nonionic)
• Negative , positive or both (Double Contrast)
• Negative room air, CO2
• Possible hazard of air is an air embolism
• Water-soluble contrast agents easily absorbed

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Contrast Mediakeep bottle in room until end of
studyhave several syringes available
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PROCEDURE PREP

• Patient Prep (none prior to exam)
• Pt comfort (gown, empty bladder)
• get history
• check allergies
• SKIN PREP
• may need to shave area of injection
• betadine scrub circular motions

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Sterile Procedure
GLOVES GOWN (?)
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Sterile tray arthrogram tray

• Aseptic technique for skin cleansing
• (betadine check for allergy)
• Local anesthetic
• (usually on tray, put may have to draw up
  sterile procedure)
• do not contaminate tray

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Aseptic Technique
betadine scrub
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ARTHROGRAM TRAY
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ARTHROGRAM TRAY
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LUMBAR PUNCTURE
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SUPPLIES

• Needles used
• length and gauge depends on part being examined
• DR may aspirate joint prior to injection of
  contrast media
• (have large syringes available)
• Sterile gauze, towels, ace bandages

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Supplies Needed
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Fluid from aspiration-Sent to lab
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KNEE ARTHOGRAM

• Most common problem
• Pain and Swelling,
• Limited ROM (range of motion)
• athletic injuries
• Knee support to stress knee
• Contrast Injected then part is stressed or
  moved to work contrast into joint spaces

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RADIOGRAPHY

• SCOUT FILMS
• AP
• LATERAL
• Other
• (CHECK WITH Radiologist)

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CONTRAST INJECTION
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KNEE ARTHROGRAM(MOST COMMON)
Air and contrast material injected into the joint
reveal the outlines of the joint space including
the supra patellar pouch
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FILMING - KNEE

• Filming done under fluoroscopy
• (Knee spot films may be done 9 on 1)
• Knee stressed to see medial and lateral meniscus
• DOUBLE CONTRAST KNEE FILMS TAKEN WITH
  HORIZONTAL BEAM
• contrast moves down air moves up shows good
  delineation of tissues

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For Cruciate
ligamentspatient may sit on end of table with
knee flexed 90 degrees

• Then a cross table lateral taken

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8 on 1 spot filming
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Knee stressed to see medial and lateral meniscus
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Ace Bandages Wrap joint after contrast injection
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MEDIAL MENISCUS
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MRI
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BAKERS CYSTa collection of synovial fluid which
has escaped from the knee joint or a bursa formed
a new synovial-lined sac in the popliteal
spaceseen in degenerative or other joint
diseases
                      
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HIP ARTHROGRAM

• Children - to check for congenital hip
  dislocation before and after treatment
• Adults to check position of hip prosthesis -
  subtraction gives better images
• Note cement in the joint and contrast have the
  same density see pg 567 Merrills

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DEVELOPMENTAL DISPLASIA OF THE HIP
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C-ARM FOR NEEDLE LOC
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SHOULDER ARTHROGRAM

• Done for evaluation of partial or complete tears
  of the ROTATOR CUFF
• Persistent Pain, Weakness and Frozen Shoulder
• May do single or double contrast - 10-12 ml of
  contrast

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SCOUT FILMS

• AP
• INTERNAL EXTERNAL ROTATION
• GRASHEY (OBL FOR FOSSA)
• AXILLARY (THUMB UP) FOR GROOVE
• TRANSTHORACIC or Y -VIEW

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Commonly people tear their cuff from falling on
an outstretched hand or throwing. This is what a
torn rotator cuff looks like.
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Single-contrast arthrogram showing rotator cuff
tear (arrow).
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WRIST ARTHROGRAM

• Trauma, persistent pain, limited rom
• Wrist gently manipulated after contrast media
  injection
• 1.5 4 ml of contrast injected

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OTHER JOINT SPACES

• ANKLE
• TMJ (USUALLY DONE IN CT)

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MORE SLIDES

• BONTRAGER CD

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