This is a slide presentation for arthrograms

1. ARTHROGRAMSARTHROGRAMS

2. ARTHROGRAM DEFINITIONARTHROGRAM DEFINITION
• CONTRAST ARTHROGRAPHY IS THE RADIOGRAPHICCONTRAST ARTHROGRAPHY IS THE RADIOGRAPHIC
EXAMINATION OF THE SOFT TISSUE STRUCTURESEXAMINATION OF THE SOFT TISSUE STRUCTURES
OF JOINTS AFTER THE INJECTION OF CONTRASTOF JOINTS AFTER THE INJECTION OF CONTRAST
MEDIAMEDIA
• RADIOPAQUE, RADIOLUCENT, OR BOTH MAY BERADIOPAQUE, RADIOLUCENT, OR BOTH MAY BE
USED (+ OR - )USED (+ OR - )
• ARTHR/O MEANS JOINT / -GRAM ………..ARTHR/O MEANS JOINT / -GRAM ………..

3. PERTAINING TERMINOLOGYPERTAINING TERMINOLOGY
• BURSA: (BURS/O) SAC OF FLUID NEAR JOINTBURSA: (BURS/O) SAC OF FLUID NEAR JOINT
• SYNOVIAL FLUIDSYNOVIAL FLUID
• SPINAL NEEDLESPINAL NEEDLE
• STERILE FIELDSTERILE FIELD
• INVASIVE PROCEDURE (SIGN CONSENT)INVASIVE PROCEDURE (SIGN CONSENT)
• POSITIVE AND NEGATIVE CONTRASTPOSITIVE AND NEGATIVE CONTRAST
• MAGNIFICATIONMAGNIFICATION
• SCOUT IMAGES (REASON WHY/BOARDSCOUT IMAGES (REASON WHY/BOARD
QUESTION)QUESTION)

4. OVERVIEWOVERVIEW
• MRI HAS LARGELY REPLACED CONTRAST ARTHROGRAPHYMRI HAS LARGELY REPLACED CONTRAST ARTHROGRAPHY
• MRI IS NONINVASIVE, SO FEWER RISKS ARE ASSOCIATEDMRI IS NONINVASIVE, SO FEWER RISKS ARE ASSOCIATED

5. CONTRAST ARTHROGRAPHYCONTRAST ARTHROGRAPHY
• MOST COMMON JOINTS STILL INVESTIGATED VIA CONTRASTMOST COMMON JOINTS STILL INVESTIGATED VIA CONTRAST
ARTHROGRAPHYARTHROGRAPHY
• KNEEKNEE
• WRISTWRIST
• HIPHIP
• SHOULDERSHOULDER
• TMJ – LESS COMMONTMJ – LESS COMMON

6. QUESTIONSQUESTIONS
• WHAT JOINT IS MOST OFTEN EXAM WITH ANWHAT JOINT IS MOST OFTEN EXAM WITH AN
ARTHROGRAM?ARTHROGRAM?
• THE SHOULDERTHE SHOULDER

7. GENERALGENERAL
PROCEDUREPROCEDURE
GUIDELINESGUIDELINES
LOCAL ANESTHETIC USEDIN AREALOCAL ANESTHETIC USEDIN AREA
OF CONTRAST INJECTIONOF CONTRAST INJECTION
LIDOCAINE 2% MOST COMMONLYLIDOCAINE 2% MOST COMMONLY
USED FOR THIS PURPOSE AT YRMCUSED FOR THIS PURPOSE AT YRMC
ALSO MAY USE XYLOCAINE 2 %ALSO MAY USE XYLOCAINE 2 %
(BUT NOT ALWAYS AS EFFECTIVE)(BUT NOT ALWAYS AS EFFECTIVE)

8. GENERALGENERAL
PROCEDUREPROCEDURE
GUIDELINESGUIDELINES
PROCEDUREPROCEDURE
PERFORMED UNDERPERFORMED UNDER
CAREFULCAREFUL ASEPTICASEPTIC
CONDITIONS (STERILECONDITIONS (STERILE
FIELD)FIELD)

9. GENERALGENERAL
PROCEDUREPROCEDURE
GUIDELINESGUIDELINES
CONTRAST ADMINISTEREDCONTRAST ADMINISTERED
UNDER FLUOROSCOPYUNDER FLUOROSCOPY
RADIOGRAPHS OR SPOTRADIOGRAPHS OR SPOT
FILMS MAY ALSO BE TAKENFILMS MAY ALSO BE TAKEN

10. GENERALGENERAL
PROCEDUREPROCEDURE
GUIDELINESGUIDELINES
JOINT EFFUSION, IF PRESENT, ISJOINT EFFUSION, IF PRESENT, IS
ASPIRATED AFTER LOCALASPIRATED AFTER LOCAL
ANESTHESIA, BUT BEFOREANESTHESIA, BUT BEFORE
CONTRAST ADMINISTRATIONCONTRAST ADMINISTRATION
AFTER CONTRAST IS INJECTED,AFTER CONTRAST IS INJECTED,
THE RADIOLOGIST MANIPULATESTHE RADIOLOGIST MANIPULATES
THE JOINT TO DISTRIBUTETHE JOINT TO DISTRIBUTE
CONTRASTCONTRAST

11. CONTRAST ARTHROGRAPHYCONTRAST ARTHROGRAPHY
• MOST COMMON JOINTS STILL INVESTIGATED VIA CONTRASTMOST COMMON JOINTS STILL INVESTIGATED VIA CONTRAST
ARTHROGRAPHYARTHROGRAPHY
• KNEEKNEE
• WRISTWRIST
• HIPHIP
• SHOULDERSHOULDER
• TMJ – LESS COMMONTMJ – LESS COMMON

12. KNEE ARTHROGRAPHYKNEE ARTHROGRAPHY
VERTICAL RAY METHODVERTICAL RAY METHOD
REQUIRES USE OF A STRESS DEVICE TOREQUIRES USE OF A STRESS DEVICE TO
WIDEN THE SIDE OF THE JOINT SPACEWIDEN THE SIDE OF THE JOINT SPACE
UNDER INVESTIGATIONUNDER INVESTIGATION
LIMB PLACED IN STRESS DEVICE AFTERLIMB PLACED IN STRESS DEVICE AFTER
CONTRAST ADMINISTRATIONCONTRAST ADMINISTRATION
IMAGES ACQUIREDIMAGES ACQUIRED
APAP
AP OBLIQUE PROJECTIONS, ROTATEDAP OBLIQUE PROJECTIONS, ROTATED
20 DEGREES TO RIGHT AND LEFT20 DEGREES TO RIGHT AND LEFT

13. KNEEKNEE
ARTHROGRAPHYARTHROGRAPHY
HORIZONTAL RAY METHODHORIZONTAL RAY METHOD
GENERALLY USES DOUBLEGENERALLY USES DOUBLE
CONTRASTCONTRAST
TO DEMONSTRATE MEDIALTO DEMONSTRATE MEDIAL
MENISCUS, POSITIONMENISCUS, POSITION
PATIENT SEMIPRONE WITHPATIENT SEMIPRONE WITH
MEDIAL MENISCUS UPMEDIAL MENISCUS UP
WIDEN JOINT SPACE WITHWIDEN JOINT SPACE WITH
MANUAL STRESSMANUAL STRESS
CR CENTERED TO MEDIALCR CENTERED TO MEDIAL
SIDE OF KNEE ON MENISCUSSIDE OF KNEE ON MENISCUS
FOR FIRST EXPOSUREFOR FIRST EXPOSURE
MAKE SUBSEQUENT FIVEMAKE SUBSEQUENT FIVE
EXPOSURES, ROTATING LIMBEXPOSURES, ROTATING LIMB
TOWARD SUPINE 30TOWARD SUPINE 30
DEGREES FOR EACHDEGREES FOR EACH
EXPOSUREEXPOSURE

14. KNEE ARTHROGRAPHYKNEE ARTHROGRAPHY
• HORIZONTAL RAY METHODHORIZONTAL RAY METHOD
• TO DEMONSTRATE LATERAL MENISCUS, POSITION PATIENTTO DEMONSTRATE LATERAL MENISCUS, POSITION PATIENT
SEMIPRONE WITH LATERAL MENISCUS UPSEMIPRONE WITH LATERAL MENISCUS UP
• FOLLOW SAME PROCEDURE USED TO DEMONSTRATE MEDIALFOLLOW SAME PROCEDURE USED TO DEMONSTRATE MEDIAL
MENISCUSMENISCUS

15. WRIST ARTHROGRAPHYWRIST ARTHROGRAPHY
• INDICATIONSINDICATIONS
• TRAUMATRAUMA
• PERSISTENT PAINPERSISTENT PAIN
• LIMITATION OF MOTIONLIMITATION OF MOTION
• PROCEDUREPROCEDURE
• 1.5 TO 4 ML OF CONTRAST INJECTED INTO DORSAL WRIST AT1.5 TO 4 ML OF CONTRAST INJECTED INTO DORSAL WRIST AT
THE ARTICULATION OF RADIUS, SCAPHOID, AND LUNATETHE ARTICULATION OF RADIUS, SCAPHOID, AND LUNATE
• WRIST MANIPULATED TO DISPERSE CONTRASTWRIST MANIPULATED TO DISPERSE CONTRAST

16. WRISTWRIST
ARTHROGRAPHYARTHROGRAPHY
COMMON PROJECTIONSCOMMON PROJECTIONS
PAPA
LATERALLATERAL
BOTH OBLIQUESBOTH OBLIQUES
FLUOROSCOPYFLUOROSCOPY
RECOMMENDED DURINGRECOMMENDED DURING
ROTATION TO DETECT LEAKSROTATION TO DETECT LEAKS
THE ANATOMY INCLUDESTHE ANATOMY INCLUDES
THREE CHAMBERS (BURSA)THREE CHAMBERS (BURSA)

17. HIPHIP
MOST OFTEN PERFORMED TOMOST OFTEN PERFORMED TO
EVALUATE CONGENITAL HIPEVALUATE CONGENITAL HIP
DISLOCATION IN CHILDRENDISLOCATION IN CHILDREN
DETECT LOOSE HIPDETECT LOOSE HIP
PROSTHESIS IN ADULTSPROSTHESIS IN ADULTS
CONFIRM INFECTION IN ADULTSCONFIRM INFECTION IN ADULTS
COMMON PUNCTURE SITECOMMON PUNCTURE SITE
¾¾′′′′ (1.9 CM) DISTAL TO INGUINAL(1.9 CM) DISTAL TO INGUINAL
CREASE AND ¾CREASE AND ¾′′′′
(1.9 CM) LATERAL TO(1.9 CM) LATERAL TO
PALPATED FEMORAL PULSEPALPATED FEMORAL PULSE

18. SHOULDERSHOULDER
PERFORMED TO EVALUATEPERFORMED TO EVALUATE
PARTIAL OR COMPLETEPARTIAL OR COMPLETE
TEARS IN ROTATOR CUFF ORTEARS IN ROTATOR CUFF OR
GLENOID LABRUMGLENOID LABRUM
PERSISTENT PAIN ORPERSISTENT PAIN OR
WEAKNESSWEAKNESS
FROZEN SHOULDERFROZEN SHOULDER
SINGLE OR DOUBLE-CONTRASTSINGLE OR DOUBLE-CONTRAST
TECHNIQUES MAY BE USEDTECHNIQUES MAY BE USED
SINGLE USES 0 TO 12 ML OFSINGLE USES 0 TO 12 ML OF
POSITIVE AGENTPOSITIVE AGENT
DOUBLE USES 2 TO 4 ML OFDOUBLE USES 2 TO 4 ML OF
POSITIVE AND 10 TO 12 MLPOSITIVE AND 10 TO 12 ML
OF AIROF AIR

19. SHOULDERSHOULDER
• COMMON PROJECTIONSCOMMON PROJECTIONS
• AP IN INTERNAL AND EXTERNAL ROTATIONAP IN INTERNAL AND EXTERNAL ROTATION
• AP OBLIQUE, 30-DEGREE OBLIQUE POSITIONAP OBLIQUE, 30-DEGREE OBLIQUE POSITION
• AXILLARYAXILLARY
• TANGENTIALTANGENTIAL
• CT AND MRI OFTEN USED IN CONJUNCTION WITH SHOULDERCT AND MRI OFTEN USED IN CONJUNCTION WITH SHOULDER
ARTHROGRAMSARTHROGRAMS

20. TMJTMJ
• CT AND MRI HAVE LARGELY REPLACED CONTRASTCT AND MRI HAVE LARGELY REPLACED CONTRAST
ARTHROGRAPHY OF TMJARTHROGRAPHY OF TMJ
• CONTRAST ARTHROGRAPHY CAN BE USEFUL IN DIAGNOSINGCONTRAST ARTHROGRAPHY CAN BE USEFUL IN DIAGNOSING
ABNORMALITIES OF ARTICULAR DISKABNORMALITIES OF ARTICULAR DISK
• SMALL, OVAL FIBROCARTILAGE LOCATED BETWEENSMALL, OVAL FIBROCARTILAGE LOCATED BETWEEN
MANDIBULAR CONDYLE AND MANDIBULAR FOSSAMANDIBULAR CONDYLE AND MANDIBULAR FOSSA

21. TMJTMJ
• PROCEDUREPROCEDURE
• PRELIMINARY TOMOGRAMS OF TMJ IN OPEN AND CLOSEDPRELIMINARY TOMOGRAMS OF TMJ IN OPEN AND CLOSED
POSITIONSPOSITIONS
• 0.5 TO 1 ML OF CONTRAST INJECTED ½0.5 TO 1 ML OF CONTRAST INJECTED ½′′′′ (1.3 CM) ANTERIOR TO(1.3 CM) ANTERIOR TO
TRAGUS OF EARTRAGUS OF EAR
• FLUOROSCOPY USED TO OBSERVE AND IMAGE MANDIBULARFLUOROSCOPY USED TO OBSERVE AND IMAGE MANDIBULAR
MOTIONMOTION
• RADIOGRAPHS MADE WITH PATIENT’S MOUTH CLOSED,RADIOGRAPHS MADE WITH PATIENT’S MOUTH CLOSED,
PARTIALLY OPEN, AND FULLY OPENPARTIALLY OPEN, AND FULLY OPEN