Conventional arthrography is a radiographic procedure used to visualize various joints or their interarticular spaces and their individual structures. In the native image (plain radiograph) of a joint, important structures belonging to the soft tissues cannot be visualized:
- Cartilaginous joint cover or joint surfaces.
- Meniscus (joint interdiscs)
- Synovia (synovial fluid)
- Recessus (joint chambers)
- Tendon sheaths
- Bursa (bursa sac)
Arthrography can be used to visualize all of these structures with the help of contrast agents. Due to the use of contrast media, the patient must be fully informed about the risks and side effects and sign a consent form.
However, conventional arthrography has now been largely supplanted by other procedures such as computed tomography (CT arthrography) and magnetic resonance imaging (MRI arthrography). Both of these techniques image the joints and associated fine structures much more precisely.
Indications (areas of application)
- Inflammatory joint diseases – e.g. chronic arthritis.
- Degenerative joint diseases – osteoarthritis (joint wear).
- Traumatic joint diseases
- Tumorous joint diseases
- Free joint bodies (osteochondrosis dissecans)
- Joint malformations – e.g. congenital hip dysplasia (malformation of the hip joint).
The procedure
The examination is performed under strictly sterile conditions. After skin disinfection, the joint space of the joint to be examined is punctured and the contrast medium is applied. As a rule, both X-ray contrast medium in the sense of a positive contrast medium procedure and air are used. The negative contrast medium procedure with air is also called pneumarthrography. The combination of both elements is called double contrast method and allows the best visualization of the joint. After application of the contrast medium, which usually takes place under fluoroscopy, the images are taken in two planes and then assessed.
In principle, all joints can be examined arthrographically. However, nowadays an indication for X-ray examination rarely arises; in most cases, computed tomography (CT) or magnetic resonance imaging (MRI) is performed. Despite all this, shoulder joint arthrography in combination with subsequent CT is a very common examination. The following joints can be arthrographically imaged:
- Shoulder joint – e.g., in cases of shoulder joint dislocation (dislocated shoulder), in cases of impingement syndrome (synonym: subacromial tightness syndrome; this syndrome is mainly suffered by athletes who overload their shoulder due to the type of sport they play. The supraspinatus tendon, thickened by overload, is increasingly pinched and the function of the shoulder joint impaired) or suspected rupture of the rotator cuff (muscles that surround the shoulder joint).
- Elbow joint
- Wrist joint
- Hip joint
- Knee joint
- Ankle joint
- Finger joints
The examination should not be performed in the presence of acute inflammation, contrast allergy, or infection of surrounding structures.