Norm of Arthrography
Intact soft-tissue structures of the joint. Absence of lesions, fractures, or tears.
Usage of Arthrography
Detection of damage to joint connective tissue and structures (that is, adhesions, tears, fractures). Specific for full-thickness triangular fibrocartilage tears, rotator cuff tears, and ankle ligament visualization. Ganglion cyst.
Description of Arthrography
Arthrography involves fluoroscopic and radiographic examination of a joint after an injection into the joint of air or radiographic dye. Arthrography provides better visualization of the connective tissue of joints than routine radiography. It is most commonly used to view the knees and shoulders but may also be performed on other joints such as the ankle, hip, wrist, or temporomandibular joint.
Professional Considerations of Arthrography
Consent form IS required.
Allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), renal toxicity; bleeding, hematoma, or infection at injection site.
Previous allergy to iodine, seafood, or radiographic dye; pregnancy; active rheumatoid arthritis; infection of the joint to be studied; pregnancy (if iodinated contract medium is used, because of crossing the blood-placental barrier).
- Obtain a sterile arthrography tray, povidone-iodine solution, and 1% to 2% lidocaine.
- Have emergency equipment readily available.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The skin is cleansed with povidone-iodine solution and allowed to dry.
- A local anesthetic (1%–2% lidocaine) is injected subdermally and subcutaneously around the site to be punctured.
- A needle is inserted into the joint space, and a small amount of contrast dye is injected through it as placement is checked under fluoroscopy.
- After correct placement is confirmed, the remainder of the dye is injected and the needle withdrawn.
- The extremity may be moved briefly through a range of motion, and then several fluoroscopic films are taken of the joint in different positions.
- Minimize use of the joint for 12 hours.
- For knee arthrography, an elastic wrap should be worn over the knee for 3–4 days.
Client and Family Teaching
- Fast from food and fluids for 8 hours before the procedure.
- Some mild pain and pressure will be felt during the procedure, but local anesthesia will be used to keep these sensations tolerable.
- Postarthrography edema and tenderness occur frequently for 1–2 days and may be treated with ice packs and mild analgesia. Symptoms lasting more than 2 days necessitate a physician's assessment.
- If air injection was used, it is normal to feel crepitus in the joint for up to 2 days, because air remains in the joint space until it dissolves into the tissues. The air causes a popping or cracking sensation when the joint moves.
Factors That Affect Results
- Fluid in the joint space decreases the quality of the films caused by dilution of the dye. If present, it should be aspirated before dye injection.
- Arthrography is 100% specific and 85% sensitive for detection of full-thickness triangular fibrocartilage tears.
- MRI and arthrography have similar diagnostic values.