ARTHROGRAMARTHROGRAMSS
ARTHROGRAM DEFINITIONARTHROGRAM DEFINITION• CONTRAST ARTHROGRAPHY IS THE RADIOGRAPHIC CONTRAST ARTHROGRAPHY IS THE RADIOGRAPHIC
EXAMINATION OF THE SOFT TISSUE STRUCTURES EXAMINATION OF THE SOFT TISSUE STRUCTURES OF JOINTS AFTER THE INJECTION OF CONTRAST OF JOINTS AFTER THE INJECTION OF CONTRAST MEDIAMEDIA• RADIOPAQUE, RADIOLUCENT, OR BOTH MAY BE RADIOPAQUE, RADIOLUCENT, OR BOTH MAY BE
USED (+ OR - )USED (+ OR - )• ARTHR/O MEANS JOINT / -GRAM ………..ARTHR/O MEANS JOINT / -GRAM ………..
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/BOARD QUESTION)SCOUT IMAGES (REASON WHY/BOARD QUESTION)
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
CONTRAST ARTHROGRAPHYCONTRAST ARTHROGRAPHY• MOST COMMON JOINTS STILL INVESTIGATED VIA CONTRAST MOST COMMON JOINTS STILL INVESTIGATED VIA CONTRAST
ARTHROGRAPHYARTHROGRAPHY• KNEEKNEE• WRISTWRIST• HIPHIP• SHOULDERSHOULDER• TMJ – LESS COMMONTMJ – LESS COMMON
QUESTIONSQUESTIONS
• WHAT JOINT IS MOST OFTEN EXAM WITH AN WHAT JOINT IS MOST OFTEN EXAM WITH AN ARTHROGRAM?ARTHROGRAM?
• THE SHOULDER THE SHOULDER
GENERAL GENERAL PROCEDURE PROCEDURE GUIDELINESGUIDELINES
LOCAL ANESTHETIC USED IN LOCAL ANESTHETIC USED IN AREA OF CONTRAST INJECTIONAREA OF CONTRAST INJECTION
LIDOCAINE 2% MOST COMMONLY LIDOCAINE 2% MOST COMMONLY USED FOR THIS PURPOSE AT YRMC USED 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)
GENERAL GENERAL PROCEDURE PROCEDURE GUIDELINESGUIDELINES
PROCEDURE PROCEDURE PERFORMED UNDER PERFORMED UNDER CAREFUL CAREFUL ASEPTICASEPTIC
CONDITIONS (STERILE CONDITIONS (STERILE FIELD)FIELD)
GENERAL GENERAL PROCEDURE PROCEDURE GUIDELINESGUIDELINES
CONTRAST ADMINISTERED CONTRAST ADMINISTERED UNDER FLUOROSCOPYUNDER FLUOROSCOPY
RADIOGRAPHS OR SPOT RADIOGRAPHS OR SPOT FILMS MAY ALSO BE TAKENFILMS MAY ALSO BE TAKEN
GENERAL GENERAL PROCEDURE PROCEDURE GUIDELINESGUIDELINES
JOINT EFFUSION, IF PRESENT, IS JOINT EFFUSION, IF PRESENT, IS ASPIRATED AFTER LOCAL ASPIRATED AFTER LOCAL
ANESTHESIA, BUT BEFORE ANESTHESIA, BUT BEFORE CONTRAST ADMINISTRATIONCONTRAST ADMINISTRATION
AFTER CONTRAST IS INJECTED, AFTER CONTRAST IS INJECTED, THE RADIOLOGIST THE RADIOLOGIST
MANIPULATES THE JOINT TO MANIPULATES THE JOINT TO DISTRIBUTE CONTRASTDISTRIBUTE CONTRAST
CONTRAST ARTHROGRAPHYCONTRAST ARTHROGRAPHY• MOST COMMON JOINTS STILL INVESTIGATED VIA CONTRAST MOST COMMON JOINTS STILL INVESTIGATED VIA CONTRAST
ARTHROGRAPHYARTHROGRAPHY• KNEEKNEE• WRISTWRIST• HIPHIP• SHOULDERSHOULDER• TMJ – LESS COMMONTMJ – LESS COMMON
KNEE ARTHROGRAPHYKNEE ARTHROGRAPHYVERTICAL RAY METHODVERTICAL RAY METHOD
REQUIRES USE OF A STRESS DEVICE TO REQUIRES USE OF A STRESS DEVICE TO WIDEN THE SIDE OF THE JOINT SPACE WIDEN THE SIDE OF THE JOINT SPACE UNDER INVESTIGATIONUNDER INVESTIGATIONLIMB PLACED IN STRESS DEVICE AFTER LIMB PLACED IN STRESS DEVICE AFTER CONTRAST ADMINISTRATIONCONTRAST ADMINISTRATIONIMAGES ACQUIREDIMAGES ACQUIRED
APAPAP OBLIQUE PROJECTIONS, ROTATED AP OBLIQUE PROJECTIONS, ROTATED 20 DEGREES TO RIGHT AND LEFT20 DEGREES TO RIGHT AND LEFT
KNEE KNEE ARTHROGRAPHYARTHROGRAPHY
HORIZONTAL RAY METHODHORIZONTAL RAY METHODGENERALLY USES DOUBLE GENERALLY USES DOUBLE CONTRASTCONTRASTTO DEMONSTRATE MEDIAL TO DEMONSTRATE MEDIAL MENISCUS, POSITION MENISCUS, POSITION PATIENT SEMIPRONE WITH PATIENT SEMIPRONE WITH MEDIAL MENISCUS UPMEDIAL MENISCUS UPWIDEN JOINT SPACE WITH WIDEN JOINT SPACE WITH MANUAL STRESSMANUAL STRESSCR CENTERED TO MEDIAL CR CENTERED TO MEDIAL SIDE OF KNEE ON MENISCUS SIDE OF KNEE ON MENISCUS FOR FIRST EXPOSUREFOR FIRST EXPOSUREMAKE SUBSEQUENT FIVE MAKE SUBSEQUENT FIVE EXPOSURES, ROTATING LIMB EXPOSURES, ROTATING LIMB TOWARD SUPINE 30 TOWARD SUPINE 30 DEGREES FOR EACH DEGREES FOR EACH EXPOSUREEXPOSURE
KNEE ARTHROGRAPHYKNEE ARTHROGRAPHY• HORIZONTAL RAY METHODHORIZONTAL RAY METHOD
• TO DEMONSTRATE LATERAL MENISCUS, POSITION PATIENT TO DEMONSTRATE LATERAL MENISCUS, POSITION PATIENT SEMIPRONE WITH LATERAL MENISCUS UPSEMIPRONE WITH LATERAL MENISCUS UP
• FOLLOW SAME PROCEDURE USED TO DEMONSTRATE MEDIAL FOLLOW SAME PROCEDURE USED TO DEMONSTRATE MEDIAL MENISCUSMENISCUS
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 AT 1.5 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
WRIST WRIST ARTHROGRAPHYARTHROGRAPHYCOMMON PROJECTIONS COMMON PROJECTIONS PAPALATERALLATERALBOTH OBLIQUESBOTH OBLIQUES
FLUOROSCOPY FLUOROSCOPY RECOMMENDED DURING RECOMMENDED DURING
ROTATION TO DETECT LEAKSROTATION TO DETECT LEAKSTHE ANATOMY INCLUDES THE ANATOMY INCLUDES
THREE CHAMBERS (BURSA)THREE CHAMBERS (BURSA)
HIPHIPMOST OFTEN PERFORMED TOMOST OFTEN PERFORMED TOEVALUATE CONGENITAL HIP EVALUATE CONGENITAL HIP DISLOCATION IN CHILDRENDISLOCATION IN CHILDRENDETECT LOOSE HIP PROSTHESIS DETECT LOOSE HIP PROSTHESIS IN ADULTSIN ADULTSCONFIRM INFECTION IN ADULTSCONFIRM INFECTION IN ADULTSCOMMON PUNCTURE SITECOMMON PUNCTURE SITE
¾¾ (1.9 CM) DISTAL TO (1.9 CM) DISTAL TO INGUINAL CREASE AND ¾INGUINAL CREASE AND ¾
(1.9 CM) LATERAL TO (1.9 CM) LATERAL TO PALPATED FEMORAL PULSE PALPATED FEMORAL PULSE
SHOULDERSHOULDERPERFORMED TO EVALUATEPERFORMED TO EVALUATEPARTIAL OR COMPLETE TEARS PARTIAL OR COMPLETE TEARS IN ROTATOR CUFF OR IN ROTATOR CUFF OR GLENOID LABRUMGLENOID LABRUMPERSISTENT PAIN OR PERSISTENT PAIN OR WEAKNESSWEAKNESSFROZEN SHOULDERFROZEN SHOULDER
SINGLE OR DOUBLE-CONTRAST SINGLE OR DOUBLE-CONTRAST TECHNIQUES MAY BE USEDTECHNIQUES MAY BE USEDSINGLE USES 0 TO 12 ML OF SINGLE USES 0 TO 12 ML OF POSITIVE AGENTPOSITIVE AGENTDOUBLE USES 2 TO 4 ML OF DOUBLE USES 2 TO 4 ML OF POSITIVE AND 10 TO 12 ML OF POSITIVE AND 10 TO 12 ML OF AIRAIR
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 SHOULDER CT AND MRI OFTEN USED IN CONJUNCTION WITH SHOULDER ARTHROGRAMSARTHROGRAMS
TMJTMJ• CT AND MRI HAVE LARGELY REPLACED CONTRAST CT AND MRI HAVE LARGELY REPLACED CONTRAST
ARTHROGRAPHY OF TMJARTHROGRAPHY OF TMJ• CONTRAST ARTHROGRAPHY CAN BE USEFUL IN DIAGNOSING CONTRAST ARTHROGRAPHY CAN BE USEFUL IN DIAGNOSING
ABNORMALITIES OF ARTICULAR DISKABNORMALITIES OF ARTICULAR DISK• SMALL, OVAL FIBROCARTILAGE LOCATED BETWEEN SMALL, OVAL FIBROCARTILAGE LOCATED BETWEEN
MANDIBULAR CONDYLE AND MANDIBULAR FOSSAMANDIBULAR CONDYLE AND MANDIBULAR FOSSA
TMJTMJ• PROCEDUREPROCEDURE
• PRELIMINARY TOMOGRAMS OF TMJ IN OPEN AND CLOSED PRELIMINARY 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 MANDIBULAR FLUOROSCOPY 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