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Arthrograms(3)
This document provides information on arthrograms, including definitions, terminology, procedures, and specifics on contrast arthrography of various joints like the knee, wrist, hip, shoulder, and TMJ. It explains that contrast arthrography involves injecting contrast media into a joint space to examine soft tissues under fluoroscopy. While MRI has replaced many arthrograms due to being noninvasive, contrast arthrography is still used to evaluate certain joints like the knee, wrist, hip and shoulder for conditions like trauma, pain, or prosthesis loosening.
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Arthrograms(3)
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- 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 HASLARGELY 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 JOINTIS MOST OFTEN EXAM WITH ANWHAT JOINT IS MOST OFTEN EXAM WITH AN ARTHROGRAM?ARTHROGRAM? • THE SHOULDERTHE SHOULDER
- 7. GENERALGENERAL PROCEDUREPROCEDURE GUIDELINESGUIDELINES LOCAL ANESTHETIC USEDINAREALOCAL 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 CAREFULCAREFULASEPTICASEPTIC CONDITIONS (STERILECONDITIONS (STERILE FIELD)FIELD)
- 9. GENERALGENERAL PROCEDUREPROCEDURE GUIDELINESGUIDELINES CONTRAST ADMINISTEREDCONTRAST ADMINISTERED UNDERFLUOROSCOPYUNDER FLUOROSCOPY RADIOGRAPHS OR SPOTRADIOGRAPHS OR SPOT FILMS MAY ALSO BE TAKENFILMS MAY ALSO BE TAKEN
- 10. GENERALGENERAL PROCEDUREPROCEDURE GUIDELINESGUIDELINES JOINT EFFUSION, IFPRESENT, 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 VERTICALRAY 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 METHODHORIZONTALRAY 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 BOTHOBLIQUESBOTH 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 PERFORMEDTOMOST 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 EVALUATEPERFORMEDTO 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 PROJECTIONSCOMMONPROJECTIONS • 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 ANDMRI 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 • PRELIMINARYTOMOGRAMS 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