Background Information:

What are the other Names for the Procedure?

• Arthrography
• Direct Arthrography

What is Arthrogram radiology procedure? (General Explanation)

An Arthrogram is an advanced imaging technique used to evaluate a joint in the body.

• It utilizes an injection of contrast material either into the joint (Direct Arthrogram) or through the bloodstream (Indirect Arthrogram). Of the two, Direct Arthrogram is more commonly used
• In this procedure, the radiologist uses specialized imaging techniques to create a short video. They may use the following techniques:
  • Continuous X-rays (fluoroscopy): A specialized film and ionizing radiation is used to generate images
  • Magnetic resonance imaging (MRI): A powerful magnet and radio waves are used to generate the images
  • Computerized tomography (CT): Carefully positioned X-rays around a structure permits 3-dimensional examination of the structure

What part of the Body does the Arthrogram Procedure involve?

An Arthrogram radiology procedure could involve various joints in the body, but is more commonly performed on the following joints:

• Shoulder
• Hip
• Elbow
• Wrist
• Ankle

Why is the Arthrogram radiology procedure Performed?

An Arthrogram radiology procedure is performed to:

• Help diagnose joint pain
• Examine structure inside the joint space
• Evaluate artificial joints

What are the Alternative Choices for the Procedure?

There are no alternatives to an Arthrogram radiology procedure.

What is the Equipment used? (Description of Equipment)

The equipment used for the procedure varies depending upon the imaging technique used by the radiologist but may include:

• A thin needle is used to inject the contrast into the joint space
• Ultrasound imaging technique using sound waves may be used to guide the needle into the joint space

Specialized imaging devices may include:

• A MRI scanner, which is a large cylinder-shaped tube that is surrounded by a circular magnet.  The patient lies on the table that slides back and forth in the cylinder tube
• A continuous X-ray device (fluoroscopy) with specialized film to provide real-time images 
• A CT scanner, which is a large cylinder-shaped tube surrounded by X-ray devices with specialized film to record the images

What are the Recent Advances in the Procedure?

There are no recent advances to an Arthrogram radiology procedure.

What is the Cost of performing the Arthrogram radiology procedure?

The cost of an Arthrogram procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding an Arthrogram procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently.

What are some Helpful Resources?

1. Watson N. Bones and joints. In: Chapman & nakielny's guide to radiological procedures. 6th ed. Philadelphia, PA: ; 2014:261-284. https://www.clinicalkey.com/#!/content/book/3-s2.0-B978070205181400012X?scrollTo=%23hl0000248. (accessed Feb 3, 2017)

Prior to Arthrogram radiology procedure:

How does the Arthrogram radiology procedure work?

If the procedure is performed under CT or continuous X-rays:

• The X-rays pass through the body and are recorded on a special film
• X-rays, produced by the machine, either pass through or are deflected by parts of the body.
• If most of the X-rays pass through a structure, it appears black (such as air-filled lungs)
• If a majority of the X-rays are deflected, it appears white (as in bones)
• Many structures (tissues usually) will appear in shades of grey
• The use of contrast helps expand the joint space and allow the tissue to be seen on film
• The result is displayed in real-time on a television-like monitor for the radiologist

If the procedure is performed under MRI guidance:

• The MRI machine uses magnetic fields and radio waves to generate signals from the body
• A computer captures these signals and reconstructs the data into images
• The use of contrast changes the signal produced by the joint space, to make it more viable

How is the Arthrogram radiology procedure Performed?

The Arthrogram radiology procedure is performed in the following manner:

• The joint to be investigated is positioned in or near the scanner
• Initial images of the joint are taken
• The skin around the joint is cleaned and a small needle is used to inject a local anesthetic around the area
• After the area is numb, a small needle is used to enter the joint capsule and inject contrast material under image guidance
• The joint is manipulated and images are taken from different angles

Where is the Procedure Performed?

The Arthrogram radiology procedure is usually performed as an outpatient procedure at a hospital.

Who Performs the Procedure?

The Arthrogram radiology procedure is performed by a radiologist.

How long will the Procedure take?

The time of the procedure may vary, but if the Arthrogram procedure is performed with continuous X-rays or CT, it should take less than 45 minutes. If the procedure is performed with MRI, it may take over one hour to complete.

Who interprets the Result?

A radiologist interprets the results of the Arthrogram radiology procedure.

What preparations are needed, prior to the Procedure?

The following preparations may be needed prior to an Arthrogram procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Patients should inform their physician, if they are allergic to any medications, especially to iodine and radioactive material used in the procedure
• Women should inform their physicians if they are breastfeeding, pregnant, or if there is a chance that they might be pregnant
• The patient may be asked to avoid eating or drinking several hours before the test

What is the Consent Process before the Procedure?

A physician will request your consent for the Arthrogram procedure using an Informed Consent Form.

Consent for the procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the procedure:

• Excellent visualization of ligaments and tendons
• Radiation does not stay inside the body

Following are the risks of the procedure:

• As with any procedure that breaks the skin, there is a small risk of infection
• There is potential to damage the joint capsule with the injection of contrast
• Rarely, some individuals may have an allergic reaction to the contrast agent

What are the Limitations of the Arthrogram radiology procedure?

Following are some limitations to Arthrogram:

• Small or partial tears surrounding a joint may be difficult to visualize, even with arthrography
• The procedure is not capable of identifying defects such as bruising of the bones

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is an Arthrogram procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Arthrogram radiology procedure:

What is expected during the Arthrogram radiology procedure?

The following may be expected during an Arthrogram radiology procedure:

• Individuals may feel a small poke and burning sensation as the radiologist administers the local anesthetic
• The area will begin to feel numb
• Generally, no pain is felt when the needle injects the contrast material, but there may be a sensation of pressure
• One may experience a sensation of fullness, after contrast is injected into the joint

What kind of Anesthesia is given, during the Procedure?

A local anesthetic is administered to numb the skin and areas around the joint capsule.

How much Blood will you lose, during the Procedure?

There is no blood loss involved during an Arthrogram radiology procedure.

What are the possible Risks and Complications during Arthrogram radiology procedure?

The possible risks and complications of an Arthrogram radiology procedure include:

• Rarely, one may develop an allergic reaction to the contrast material used
• Some pain may be felt during the injection of contrast material into the joint space
• In rare cases, the joint capsule may rupture following the injection
• As with any procedure that involves breaking the skin, there is a small risk of infection
• There is a small possibility of damaging surrounding structures such as the arteries or nerves

What Post-Operative Care is needed at the Healthcare Facility after the Arthrogram radiology procedure?

No post-operative care is need at the healthcare facility following an Arthrogram radiology procedure.

After the Arthrogram radiology procedure:

What is to be expected after the Arthrogram radiology procedure?

The following may be expected after the Arthrogram radiology procedure:

• Some individuals experience swelling and discomfort in the joint that was imaged
• The healthcare provider may ask to avoid any physical activity for 24 hours following the procedure
• He/she may also recommend taking over-the-counter medicine for pain control

When do you need to call your Physician?

If the swelling and pain persists 2 days after the procedure, contact your healthcare provider.

What Post-operative care is needed at Home after the Arthrogram radiology procedure?

• The healthcare provider may suggest over-the-counter pain medication for the first 48 hours, after the procedure
• Individuals may be asked to avoid strenuous activity for at least 24 hours following the procedure

How long does it normally take to fully recover, from the Procedure?

In general, no additional recover time is required and one may be able to resume normal activities in 24 hours.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

An Arthrogram radiology procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Arthrogram radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Arthrogram procedure is performed.