Test Overview

An arthrogram is a test using
X-rays to obtain a series of pictures of a
joint after a
contrast material (such as a dye, water, air, or a
combination of these) has been injected into the joint. This allows your doctor
to see the soft tissue structures of your joint, such as
tendons,
ligaments, muscles,
cartilage, and your joint capsule. These structures
are not seen on a plain X-ray without contrast material. A special type of
X-ray, called
fluoroscopy, is used to take pictures of the
joint.

An arthrogram is used to check a joint to find out what is
causing your symptoms or problem with your joint. An arthrogram may be more
useful than a regular X-ray because it shows the surface of soft tissues lining
the joint as well as the joint bones. A regular X-ray only shows the bones of
the joint. This test can be done on your hip, knee, ankle, shoulder, elbow,
wrist, or jaw (temporomandibular joint).

Other tests, such as
magnetic resonance imaging (MRI) and
computed tomography (CT), give different information
about a joint. They may be used with an arthrogram or when an arthrogram does
not give a clear picture of the joint.

Why It Is Done

An arthrogram is used to find the
cause of ongoing, unexplained joint pain, swelling, or abnormal movement of
your joint. It may be done alone, before, or as part of other tests, such as
MRI, CT, or
arthroscopy.

An arthrogram is used to:

  • Find problems in your joint capsule, ligaments,
    cartilage (including tears, degeneration, or disease), and the bones in the
    joint. In your shoulder, it may be used to help find
    problems such as rotator cuff tears.
  • Find abnormal growths or
    fluid-filled
    cysts.
  • Confirm that a needle has been
    placed correctly in your joint before joint fluid analysis, a test in which a
    sample of joint fluid is removed with a thin needle.
  • Check needle
    placement before a painkilling injection, such as a
    corticosteroid injection.

How To Prepare

Tell your doctor before your
arthrogram if you:

  • Are or might be pregnant.
  • Are
    allergic to any type of contrast material.
  • Are allergic to iodine.
    The dye used for an arthrogram may contain iodine.
  • Are allergic to
    any medicines, including anesthetics.
  • Have ever had a serious
    allergic reaction (anaphylaxis) from any substance, such
    as a bee sting or eating shellfish.
  • Have
    asthma.
  • Have bleeding problems or are
    taking blood-thinning medicines.
  • Have
    arthritis that is bothering you at the time of your
    test.
  • Have a known infection in or around your joint. The dye may
    make your infection worse.
  • Have
    diabetes or take metformin (Glucophage) for your
    diabetes.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the
test, its risks, how it will be done, or what the results will mean. To help
you understand the importance of this test, fill out the
medical test information form (What is a PDF document?).

How It Is Done

An arthrogram is usually done by a
doctor who specializes in interpreting X-rays (radiologist).

You will be asked to remove
any jewelry or metal objects from the joint area. You will then sit or lie down
with your joint under an X-ray viewer (fluoroscope)
that is hooked to a video screen that can show X-ray pictures. The skin over
your joint is cleaned with a special soap and draped with sterile towels. A
local anesthetic is used to numb the skin and tissues
over the joint.

A needle is put into your joint area. Joint fluid
may be removed so that more contrast material (such as dye or air) can be put
into the joint. A sample of joint fluid may be sent to a lab to be looked at
under a microscope. The fluoroscope shows that the needle is placed correctly
in your joint. The dye or air is then put through the needle into your joint.
The joint may be injected with both dye and air (double-contrast arthrogram).
The needle is then removed.

You may be asked to move your joint
around to help the dye or air spread inside your joint. Pictures from the
fluoroscope show if the dye has filled your entire joint. Hold as still as
possible while the X-rays are being taken unless your doctor tells you to move
your joint through its entire
range of motion. The X-rays need to be taken quickly,
before the dye spreads to other tissues around your joint.

If you
are having a CT scan or MRI after an arthrogram, a small amount of a medicine
called epinephrine may be mixed with the dye to stop the dye from spreading
into other tissues.

An arthrogram usually takes about 30 to 60
minutes.

After the arthrogram, rest your joint for about 12 hours.
Do not do any strenuous activity for 1 to 2 days. Use ice for any swelling and
use pain medicine for any pain. If a bandage or wrap is put on your joint
following an arthrogram, you will be told how long to use it.

How It Feels

You will feel a prick and sting when the
anesthetic is given. You may feel tingling, pressure, pain, or fullness in your
joint as the dye is put in.

The X-ray table may feel hard and the
room may be cool.

You may have some mild pain, tenderness, and
swelling in your joint after the test. Ice packs and nonprescription pain relievers, used as the package directs, may help you feel more comfortable. You may also hear a grating, clicking,
or cracking sound when you move your joint. This is normal and goes away in
about 24 hours. If you have ongoing pain, tenderness, or swelling of the joint,
tell your doctor.

Risks

You can have a few problems from an arthrogram,
such as:

  • Joint pain for more than 1 or 2
    days.
  • An allergic reaction to the dye.
  • Damage to the
    structures inside your joint or bleeding in the joint. But this is very rare
    because the needle that is used is small.
  • Infection in the joint.

There is always a slight risk of damage to cells or tissue
from being exposed to any radiation, including the low levels of radiation used
for this test. But the risk of damage from the X-rays is usually very low
compared with the potential benefits of the test.

Results

An arthrogram is a test using
X-rays to obtain a series of pictures of a
joint after a
contrast material (such as a dye, water, air, or a
combination of these) has been injected into the joint. The radiologist may
discuss the initial results with you after he or she reviews all the pictures.
A detailed report will be available to your doctor in a few days.

Arthrogram
Normal:

The joint capsule, the sac
containing joint fluid, is normal. The cartilage and other structures of the
joint are normal.

Abnormal:

The cartilage is worn down
(degeneration) or there is a tear in the cartilage cushion of the joint.

There is a tear in the ligaments or tendons of the joint. The tear may be
partial or complete. If a
rotator cuff tear in the shoulder is present, the dye
leaks from the tear.

The joint capsule is enlarged or has
ruptured. A joint cyst is present.

Abnormal material is present in
the joint. This could be a tumor, extra growth of joint tissues, or pieces of
bone or cartilage.

After your doctor has seen the condition of your joint
area, further treatment with medicine, physical therapy, or surgery may be
recommended.

What Affects the Test

Reasons you may not be able to
have the test or why the results may not be helpful include:

  • If you can’t hold still during the test. The
    pictures may not be clear.
  • If there is a large amount of fluid in
    your joint. This may affect the spread of the dye and the pictures.

What To Think About

  • Magnetic resonance image (MRI) and computed
    tomography (CT) give different information about a joint. These tests may be
    used with an arthrogram or when an arthrogram does not give a clear picture.
    Also, an MRI or
    arthroscopy may be used before or in addition to an
    arthrogram to check your joint problem.

  • An arthrogram may be done if
    other tests, such as MRI, are not available. It also may be done to help your
    doctor decide whether arthroscopic surgery is needed.
  • An arthrogram is
    usually not done during pregnancy.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Howard Schaff, MD – Diagnostic Radiology

Current as ofOctober 9, 2017