Arthrograms(3)

This is a slide presentation for arthrograms

1. ARTHROGRAMSARTHROGRAMS

2. 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 ………..

3. 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 SCOUT IMAGES (REASON WHY/BOARD
QUESTION)QUESTION)

4. 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

5. 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

6. QUESTIONSQUESTIONS
•WHAT JOINT IS MOST OFTEN EXAM WITH AN WHAT JOINT IS MOST OFTEN EXAM WITH AN
ARTHROGRAM?ARTHROGRAM?
•THE SHOULDER THE SHOULDER

7. GENERAL GENERAL
PROCEDURE PROCEDURE
GUIDELINESGUIDELINES
LOCAL ANESTHETIC USED IN AREA LOCAL ANESTHETIC USED IN AREA
OF CONTRAST INJECTIONOF 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)

8. GENERAL GENERAL
PROCEDURE PROCEDURE
GUIDELINESGUIDELINES
PROCEDURE PROCEDURE
PERFORMED UNDER PERFORMED UNDER
CAREFUL CAREFUL ASEPTICASEPTIC
CONDITIONS (STERILE CONDITIONS (STERILE
FIELD)FIELD)

9. GENERAL GENERAL
PROCEDURE PROCEDURE
GUIDELINESGUIDELINES
CONTRAST ADMINISTERED CONTRAST ADMINISTERED
UNDER FLUOROSCOPYUNDER FLUOROSCOPY
RADIOGRAPHS OR SPOT RADIOGRAPHS OR SPOT
FILMS MAY ALSO BE TAKENFILMS MAY ALSO BE TAKEN

10. GENERAL GENERAL
PROCEDURE PROCEDURE
GUIDELINESGUIDELINES
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 MANIPULATES THE RADIOLOGIST MANIPULATES
THE JOINT TO DISTRIBUTE THE JOINT TO DISTRIBUTE
CONTRASTCONTRAST

11. 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

12. KNEE ARTHROGRAPHYKNEE ARTHROGRAPHY
VERTICAL 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 INVESTIGATION
LIMB PLACED IN STRESS DEVICE AFTER LIMB PLACED IN STRESS DEVICE AFTER
CONTRAST ADMINISTRATIONCONTRAST ADMINISTRATION
IMAGES ACQUIREDIMAGES ACQUIRED
APAP
AP OBLIQUE PROJECTIONS, ROTATED AP OBLIQUE PROJECTIONS, ROTATED
20 DEGREES TO RIGHT AND LEFT20 DEGREES TO RIGHT AND LEFT

13. KNEE KNEE
ARTHROGRAPHYARTHROGRAPHY
HORIZONTAL RAY METHODHORIZONTAL RAY METHOD
GENERALLY USES DOUBLE GENERALLY USES DOUBLE
CONTRASTCONTRAST
TO DEMONSTRATE MEDIAL TO DEMONSTRATE MEDIAL
MENISCUS, POSITION MENISCUS, POSITION
PATIENT SEMIPRONE WITH PATIENT SEMIPRONE WITH
MEDIAL MENISCUS UPMEDIAL MENISCUS UP
WIDEN JOINT SPACE WITH WIDEN JOINT SPACE WITH
MANUAL STRESSMANUAL STRESS
CR CENTERED TO MEDIAL CR CENTERED TO MEDIAL
SIDE OF KNEE ON MENISCUS SIDE OF KNEE ON MENISCUS
FOR FIRST EXPOSUREFOR FIRST EXPOSURE
MAKE SUBSEQUENT FIVE MAKE SUBSEQUENT FIVE
EXPOSURES, ROTATING LIMB EXPOSURES, ROTATING LIMB
TOWARD SUPINE 30 TOWARD SUPINE 30
DEGREES FOR EACH DEGREES FOR EACH
EXPOSUREEXPOSURE

14. 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

15. 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

16. WRIST WRIST
ARTHROGRAPHYARTHROGRAPHY
COMMON PROJECTIONS COMMON PROJECTIONS
PAPA
LATERALLATERAL
BOTH OBLIQUESBOTH OBLIQUES
FLUOROSCOPY FLUOROSCOPY
RECOMMENDED DURING RECOMMENDED DURING
ROTATION TO DETECT LEAKSROTATION TO DETECT LEAKS
THE ANATOMY INCLUDES THE ANATOMY INCLUDES
THREE CHAMBERS (BURSA)THREE CHAMBERS (BURSA)

17. HIPHIP
MOST OFTEN PERFORMED TOMOST OFTEN PERFORMED TO
EVALUATE CONGENITAL HIP EVALUATE CONGENITAL HIP
DISLOCATION IN CHILDRENDISLOCATION IN CHILDREN
DETECT LOOSE HIP DETECT LOOSE HIP
PROSTHESIS IN ADULTSPROSTHESIS IN ADULTS
CONFIRM INFECTION IN ADULTSCONFIRM INFECTION IN ADULTS
COMMON PUNCTURE SITECOMMON PUNCTURE SITE
¾¾¢¢¢¢ (1.9 CM) DISTAL TO INGUINAL (1.9 CM) DISTAL TO INGUINAL
CREASE AND ¾CREASE AND ¾¢¢¢¢
(1.9 CM) LATERAL TO (1.9 CM) LATERAL TO
PALPATED FEMORAL PULSE PALPATED FEMORAL PULSE

18. SHOULDERSHOULDER
PERFORMED TO EVALUATEPERFORMED TO EVALUATE
PARTIAL OR COMPLETE PARTIAL OR COMPLETE
TEARS IN ROTATOR CUFF OR TEARS IN ROTATOR CUFF OR
GLENOID LABRUMGLENOID LABRUM
PERSISTENT PAIN OR PERSISTENT PAIN OR
WEAKNESSWEAKNESS
FROZEN SHOULDERFROZEN SHOULDER
SINGLE OR DOUBLE-CONTRAST SINGLE OR DOUBLE-CONTRAST
TECHNIQUES MAY BE USEDTECHNIQUES MAY BE USED
SINGLE USES 0 TO 12 ML OF SINGLE USES 0 TO 12 ML OF
POSITIVE AGENTPOSITIVE AGENT
DOUBLE USES 2 TO 4 ML OF DOUBLE USES 2 TO 4 ML OF
POSITIVE AND 10 TO 12 ML POSITIVE AND 10 TO 12 ML
OF AIROF AIR

19. 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

20. 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

21. 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