1. 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 MRI has largely replaced contrast arthrography –Noninvasive –fewer risks are associated

2. Contrast Media Air Air –Negative contrast Iodinated contrast Iodinated contrast –Positive contrast

3. Knee Knee Hip Hip Shoulder Shoulder Wrist Wrist TMJ TMJ Most common joints investigated using contrast arthrography

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

5. Contraindications (Applies to all arthrograms) Skin infections Skin infections Bleeding tendency Bleeding tendency Anti-coagulent therapy Anti-coagulent therapy Allergy to contrast Allergy to contrast

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

7. Procedure cont’d Contrast introduced through needle under fluoroscopic guidance Contrast introduced through needle under fluoroscopic guidance Needle is removed Needle is removed Pt asked to exercise knee to distribute contrast Pt asked to exercise knee to distribute contrast Pt is then turned prone if vertical method is used Pt is then turned prone if vertical method is used Spot radiographs are obtained by Radiologist Spot radiographs are obtained by Radiologist Overheads Overheads

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

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

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

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

12. Radiographs AP AP Internal and external rotations Internal and external rotations Frog lateral Frog lateral

13. TMJ Arthrography TMJ Arthrography CT and MRI have largely replaced CT and MRI have largely replaced Indications for Arthrogram of TMJ Diagnosing abnormalities of articular disk Diagnosing abnormalities of articular disk Subluxation ( Incomplete or partial dislocation of bone in joint) Aplasia- (defective development) Fx. Ankylosis- (stiffness of jt) Arthritis

14. TMJ Arthrography Procedure: Contrast injected ½  anterior to tragus of ear Contrast injected ½  anterior to tragus of ear Fluoroscopy used to observe and image mandibular motion Fluoroscopy used to observe and image mandibular motion Radiographs made with pt’s mouth closed, partially open, and fully open Radiographs made with pt’s mouth closed, partially open, and fully open

15. Shoulder Arthrography Indications: Rotator cuff or long head of biceps tears Rotator cuff or long head of biceps tears Foreign bodies Foreign bodies Persistent pain or weakness Persistent pain or weakness Frozen shoulder Frozen shoulder After injection, take standard shoulder projections CT often used in conjunction with shoulder arthrograms

16. Shoulder Arthrograpy Rotator Cuff Tear Normal

17. Wrist Arthrography Indications IndicationsTrauma Persistent pain Limitation of motion Procedure Procedure Contrast injected into dorsal wrist dorsal wrist Wrist manipulated to disperse contrast disperse contrast Routine images