What is an arthrogram?
An arthrogram (also known as arthrography) is a diagnostic imaging procedure that helps doctors visualize the bones, cartilage, ligaments, and tendons within a joint. Most arthrograms use a contrast agent to highlight abnormalities in the joint. Arthrograms are especially useful for determining the cause of unexplained joint pain or trouble moving the joint. Fluoroscopy is frequently used for arthrograms because this technique allows the radiologist to see what happens inside the joint and to visualize it in motion.
- Indirect – Joint is visualized after administering an intravenous (IV) contrast agent that eventually is absorbed into the joint.
- Direct – The contrast agent is injected directly into the joint. This method expands the joint and provides a better view of internal joint structures.
More basic information on fluoroscopy is available in the About Fluoroscopy section.
An arthrogram is recommended when a doctor, typically an orthopedic surgeon, requires visualization of the interior of a joint. For example, if you had a joint injury, an arthrogram might be recommended to determine the extent of injury. Arthrograms are used to evaluate problems in a variety of joints, such as the shoulder, elbow, wrist, hip, knee, and ankle. In addition, arthrograms are used for the following:
- Detect growths or synovial cysts in the joint
- Find tears, degeneration, or disease
- Diagnose unexplained joint pain
- Determine need for treatment and develop treatment plan
Arthrograms are a diagnostic tool that may aid in determining whether you require surgery for a joint problem.
- Arthrograms are a minimally invasive way for doctors to evaluate the interior of a joint. This could avoid the need for surgical exploration of the joint.
- Even if joint surgery is eventually required, arthrography helps surgeons have more detailed information about the joint prior to surgery. This may improve outcomes or shorten the length of surgery.
- A variety of problems can be evaluated by arthrogram. For example, doctors can evaluate the shoulder for dislocation or the knees for damage to cartilage and ligaments.
- Unlike MRI, if you have metal in your body (shrapnel, bullets, needles, etc.) or an implanted medical device, you can still have fluoroscopic arthrography since no magnets are used in the procedure.
- There is a very small chance of infection when the joint being examined is injected. Your radiologist or technologist is fully trained in using sterile techniques to minimize the chance of infection.
- In rare cases, blood vessels or nerves near the joint may be injured during injection.
- Fluoroscopy uses a low dose of radiation because it uses X-ray technology, but the benefit of an accurate diagnosis far outweighs the risk. Please refer to the section Fluoroscopy for more information on the risk of radiation used in this exam.
- Pregnant women should be aware of the risk of radiation to the developing child. For more details, please refer to the section What if I am pregnant? Can I still have fluoroscopy?
- The American College of Radiology (ACR) says that current information suggests that breastfeeding is safe after the use of intravenous contrast. Please discuss your breastfeeding options with your medical provider.
- The risk of negative side effects due to contrast are rare. Refer to the Fluoroscopy section for more details about the risks of different types of contrast.
- Arthrogram is typically done in an ARA imaging center and takes a total of about 30 minutes.
- Depending on the joint being examined, you may be asked to change into a gown.
- You may have regular X-rays taken at first to help guide joint injection and to have a baseline exam to refer to later.
- For direct arthrograms, the area to be injected is cleansed with antiseptic, and a sterile drape is placed around the injection site. Using a small needle, your doctor will inject local anesthetic first.
- Once the area is numb, a larger needle will be used to inject the contrast material. In some cases, joint fluid is removed with a needle prior to injection.
- Once the contrast is injected, you may be asked to move the joint to distribute the contrast.
- For indirect arthrograms, you will be given intravenous (IV) contrast. Your technologist will place an IV line into your arm or hand to administer the contrast agent. IV placement may be uncomfortable and may cause minor bruising later. A saline solution drip may be used to help keep the IV line from clogging.
- The radiologist will visualize the joint using fluoroscopy, which is a device like a standard X-ray machine but with the ability to show your body in real-time motion.
- Medication, such as steroids, may be injected into the joint during the exam for treatment purposes.
- You may have soreness, swelling, or a feeling of fullness around your joint after the procedure. Do not overuse or stress the joint directly for a few days after the arthrogram, and use ice application to help with any swelling or discomfort.
- Wear comfortable, loose-fitting clothing.
- For indirect arthrograms, you will be asked to lie down on a table and given intravenous (IV) contrast. You may be asked not to eat or drink for a few hours prior to the exam. In most cases, you should take all your medications as usual. Ask your medical provider for specific directions about your daily medications.
- For direct arthrograms, you can eat and take your medications as usual.
- Be sure to tell your radiologist about any illness or allergies you may have. Also, provide a list of your current medications.
- Inform your radiologist if you are pregnant. Pregnant women should not receive IV contrast or undergo X-ray unless the benefits clearly outweigh the risks. However, depending on the circumstances, both the medical provider and patient may decide it is necessary to go ahead with the arthrogram. For more details, please refer to the section What if I am pregnant? Can I still have fluoroscopy?
- Some doctors recommend that breastfeeding women wait 24 to 48 hours until the contrast clears from their system before breastfeeding again. Before the procedure, breastfeeding women may want to pump breastmilk for the time following the procedure.
A radiologist, a physician specifically trained to interpret radiological examinations, will analyze the images and send a signed report to the provider who referred you to ARA. The physician will then share the results with you. Your report will also be available on the patient portal within 15 days.