Arthrograms(3)

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)


PROCEDURE PROCEDURE PERFORMED UNDER PERFORMED UNDER CAREFUL CAREFUL ASEPTICASEPTIC

CONDITIONS (STERILE CONDITIONS (STERILE FIELD)FIELD)


CONTRAST ADMINISTERED CONTRAST ADMINISTERED UNDER FLUOROSCOPYUNDER FLUOROSCOPY

RADIOGRAPHS OR SPOT RADIOGRAPHS OR SPOT FILMS MAY ALSO BE TAKENFILMS MAY ALSO BE TAKEN


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

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Arthrograms(3)