Arthrography Health Article

Aftercare

The affected joint should be rested for approximately 12 hours following the procedure. Swelling may occur and can be treated with an application of ice or cold packs. A mild pain reliever may also be necessary to lessen discomfort for the first 12 hours. Noises in the joint such as cracking or clicking are normal for a few hours following an arthrogram. These noises are the result of the extra liquid (contrast) and air in the joint.

Complications

Some patients may have allergic reactions to iodine, ranging from mild nausea or a rash to severe cardiac and resiratory problems. Since the contrast material is injected directly into a joint, however, rather than the venous circulation, allergic reactions are rare. Facilities licensed to perform contrast examinations should meet requirements for emergency equipment, supplies and staff training in order to handle a possible severe reaction. Non-ionic contrast material is also available in most radiology departments.

Arthrographic studies should not be done on patients with a known joint infection, bleeding problems, or severe active arthritis.

Results

A normal arthrogram demonstrates a normal joint space with no damage to the articular cartilage, tendons, ligaments or bursae. Partial or incomplete tears of the rotator cuff are better demonstrated using MRI imaging.

Abnormal results of an arthrogram may indicate partial or complete tears of the rotator cuff, demonstrated as a leakage of contrast material out of the joint and into the bursa. In a knee arthrogram, meniscal tears are demonstrated as well as problems with the ligaments or evidence of a popliteal cyst, commonly referred to as a Baker's cyst. A Baker's cyst is demonstrated on the radiographs

as an extension of fluid into the popliteal fossa located behind the knee. Dislocations of the hip are visible as well as a loose hip prosthesis. Joint space narrowing and arthritis are also visualized on an arthrogram.

Health care team roles

Since a reaction to an iodine-based contrast medium is always a risk in arthrography, the x-ray technologist must be familiar with emergency procedures in place to deal with a cardiac arrest. The x-ray technologist works closely with the radiologist during this procedure and must be familiar with sterile techniques in order to prevent infection.

Patient education

The radiography technologist explains the procedure to the patient and inquires about any known allergies and the possibility of pregnancy. Since many patients are nervous about an injection directly into the joint, the x-ray technologist must assure the patient that the area will be numbed in advance with a local anesthetic. During a knee arthrogram the radiologist manually positions the patient, so the patient must be encouraged to relax the knee completely. All radiography technologists must be certified and registered with the A.S.R.T. and are required to obtain continued education credits to maintain their credentials.

Following the arthrogram, the patient is also instructed to put ice on the affected joint and to take a mild pain reliever if necessary.

KEY TERMS

Aspirate—To remove fluids by suction, often through a needle.

Bursa—A closed space between two moving surfaces containing a small amount of lubricating fluid to reduce friction in the joint.

Contrast (agent, medium)—A substance injected into the body that outlines certain structures that would otherwise be hard to see on the radiograph (film).

Fluoroscope—An under-table x-ray tube used to visualize structures in real time on a television screen.

Fossa—An anatomical cavity or hollow.

Meniscus—A wedge of cartilage that separates the articulating bones in certain joints.

Popliteal—Pertaining to the area at the back of the knee.

Rotator cuff—A group of muscles lying outside the shoulder joint that allow the joint to move in many directions.

X ray—A form of electromagnetic radiation with shorter wavelengths than normal light. X-rays can penetrate most structures.

BOOKS

Ballinger, Phillip. Merill's Atlas of Radiographic Positioning, 6th ed. St. Louis, MO: CV Mosby Publishing.

Eisenberg, Ronald. Clinical Imaging: Atlas of Differential Diagnosis, 3rd ed. New York: Thieme Publishing, 1997.

ORGANIZATIONS

American College of Radiology. 1891 Preston White Drive. Reston, VA 22091. (800) ACR-LINE. <http://www.acr.org>.

The Arthritis Foundation. 1330 West Peachtree Street. Atlanta, GA 30309. (800) 283-7800. <http://www.arthritis.org>.

Lorraine K. Ehresman