1. Chapter 12 Contrast Arthrography 9 25 2014 online ed.

2. What is contrast arthrography? What is contrast arthrography? Radiographic examination of soft tissue structures of joints after injection of contrast media MRI has largely replaced contrast arthrography Noninvasive fewer risks are associated

3. Contrast Media Air Negative contrast Iodinated contrast Positive contrast

4. KneeWristHipShoulderTMJ What are most common joints investigated using contrast arthrography?

5. Knee Arthrography To assesse soft tissue areas of knee joint Cruciate ligament Medial and lateral menisci

6. What are menisci? Two pads of cartilaginous tissue Serve to of joint Serve to disperse weight of body and reduce friction during movement of joint

7. Procedure Indications Cartilage, capsular injuries Ligament or menisci injuries Loose bodies Joint rupture Baker’s cyst Synovial disease Prosthesis check

8. Procedure Skin is first cleaned with betadine Local anesthetic is introduced Joint is punctured (synovial fluid may be aspirated and sent for analysis)

9. Thick, stringy fluid found in cavities of synovial joints Reduces friction between articular cartilage and other tissues in joints Lubricates and cushions during movement What is synovial fluid?

10. Procedure cont’d Contrast introduced under fluoroscopic guidance Needle is removed Pt exercises knee to distribute contrast Pt is then turned prone if vertical method is used Spot radiographs are obtained

11. Vertical ray method Beam shoots down (or up if using fluoroscopy) Limb placed in stress device to widen side of jt space under investigation

12. Typical Spot films taken under fluoro by Radiologist (Don’t need to learn for midterm) Prone 30º lateral anterior oblique 45º oblique 60º lateral posterior oblique 90º lateral Views are then reversed, beginning with pt supine to demonstrate lateral meniscus Stress is applied to open the joint space during exposure

13. Horizontal ray method To demonstrate lateral and medial meniscus Same procedure as with Vertical method but with crosstable CR (fluoroscopy not possible) Tear in medial meniscus Normal

14. Post-Procedure Overhead radiographs by tech may be requested: –AP, lateral, tunnel, lateral views Make sure puncture area is properly bandaged Pt may experience some discomfort for a couple of days Discourage heavy exercise

15. Hip Arthrography Acetabular region of pelvis What kind of joint is hip? Diarthrotic- ball and socket joint Allows flexion, extension, abduction, adduction, rotation

16. Hip Arthrography cont’d Most often performed on children to evaluate hip dislocation before treatment In adults, primarily to check prosthesis dislocation or presence of infection Common puncture site –¾  distal to inguinal crease and ¾  lateral to palpated femoral pulse and ¾  lateral to palpated femoral pulse

17. Contraindications Infections Allergy to contrast Bleeding problems

18. Hip Procedure After preparation, aspiration, and injection, pt is supinated Joint is gently manipulated after injection Radiographs must be obtained immediately as contrast is rapidly absorbed

19. Radiographs AP Internal and external rotations Frog lateral

20. Hip Arthrogram w/Prosthesis

21. Hip Arthrogram With “subtraction” Radiopaque cement can be hard to distinquish from contrast

22. Pediatric Hip Arthrogram

23. TMJ Arthrography TMJ Arthrography CT and MRI have largely replaced TMJ –What kind of joint? Hinge and gliding jt Useful in diagnosing abnormalities of articular disk (Small, oval fibrocartilage located between mandibular condyle and mandibular fossa)

24. Indications for Arthrogram of TMJ Subluxation ( Incomplete or partial dislocation of bone in joint)

25. More indications for performing exam Aplasia- (defective development) Fx Ankylosis- (stiffness of jt) Arthritis

26. TMJ

27. Shoulder Arthrography Indications: Rotator cuff or long head of biceps tears Foreign bodies Persistent pain or weakness Frozen shoulder

28. Shoulder Arthrograpy Rotator Cuff Tear Normal

29. Wrist Arthrography IndicationsTrauma Persistent pain Limitation of motion Procedure Contrast injected into dorsal wrist Wrist manipulated to disperse contrast

30. The End