What is arthrography?

Arthrography is a type of imaging test used to look at a joint, such as the shoulder, knee, or hip. It may be done if standard X-rays do not show the needed details of the joint structure and function.

In direct arthrography, a long, thin needle is used to put contrast dye right into the joint and a series of X-rays is taken with the joint in various positions. Indirect arthrography is when the contrast dye is put into a vein and absorbed into the joint before the X-rays are taken. X-rays use small amounts of radiation to get pictures of the inside of the body.

An arthrogram may also use fluoroscopy, CT, or MRI imaging instead of X-rays to get better pictures of the joint.

While arthrography is most commonly used to examine the knee and shoulder joints, it may also be used to look at other joints, such as the wrist, ankle, hip, or elbow.

Why might I need arthrography?

Arthrography may be done on a joint when there has been persistent and unexplained pain, discomfort, and/or changes in the way the joint works. Other reasons to do this test may include:

  • To find problems (such as tears) in the soft tissues of the joint, such as ligaments, cartilage, and joint capsules
  • To check for damage from recurrent dislocations of the joint
  • To locate synovial cysts (sacs of the lubricating fluid in the joint)

There may be other reasons for your doctor to recommend arthrography.

What are the risks of arthrography?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure, such as previous CT scans and other types of X-rays, so that you can inform your doctor. Risks linked with radiation exposure may be related to the cumulative number of X-ray exams and/or treatments over a long period.

If you are allergic or sensitive to medications, contrast dyes, local anesthesia, iodine, or latex, tell your doctor.

Some potential risks of arthrography include:

  • Infection at the needle site where the contrast dye is injected
  • Allergic reaction to the contrast dye; but this is rare with direct arthrography because the dye is not injected into a vein

Arthrography is not recommended for people with active arthritis or joint infections.

If you are pregnant or think you may be, tell your doctor. Radiation exposure during pregnancy may lead to birth defects. If you must have an arthrography exam, special precautions will be taken to minimize the radiation exposure to the fetus.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

How do I get ready for arthrography?

  • Your doctor will explain the procedure to you and you can ask questions.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
  • There is no special restriction on diet or activity before arthrography.
  • Be sure to tell your doctor if you are sensitive to or are allergic to any medications, latex, tape, anesthetic agents (local and general), contrast dyes, and/or iodine.
  • Tell your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. You may need to stop these medications prior to the procedure.
  • If you are pregnant or think you may be, tell your health care provider.
  • Based on your medical condition, your doctor may give you other instructions on what to do before the procedure.

What happens during arthrography?

Arthrography may be done on an outpatient basis or as part of your stay in the hospital. Procedures may vary depending on your condition and your doctor's practices.

Generally, arthrography follows this process:

  1. You will be asked to remove any clothing, jewelry, or other objects that might get in the way. A bracelet with your name and an identification number may be put on your wrist. You may get a second bracelet if you have allergies.
  2. If you are asked to remove your clothing, you will be given a gown to wear.
  3. You will be positioned on an exam table in the procedure room.
  4. X-rays of the joint may be taken before the injection of the contrast dye for comparison with the pictures taken after the dye is injected.
  5. The skin around the joint will be covered with sterile drapes and cleaned with an antiseptic solution.
  6. The area around the joint will be numbed by using a small needle to inject a local anesthetic (numbing drug). You may feel burning before you feel a numbing sensation.
  7. If there is fluid in the joint, this fluid will be removed with a longer needle and syringe.
  8. The contrast dye will be injected into the joint using a long, thin needle. You may feel pressure as the needle is moved into the joint, but tell the doctor if it hurts so more numbing medicine can be used. After this injection, you may be asked to move the joint so that the dye moves evenly throughout the joint. You may be asked to exercise the joint. For instance, in the case of knee arthrography, you may be asked to walk around for a few minutes.
  9. Once the contrast dye has moved through the joint, multiple X-rays will be taken with the joint in various positions. In some cases, a special frame or traction may be used to stretch the joint for a wider view of the joint. Things like pillows or sandbags may be used to help position the joint. In most cases, you will get an MRI, or less commonly, a CT, after the arthrogram has been done.

While the arthrography procedure itself causes no pain, having to move or hold the joint still in certain positions might cause some discomfort or pain, particularly if you’ve recently had surgery or a joint injury. The technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.

What happens after arthrography?

Your doctor will give you specific instructions regarding movement of the joint, pain medication, care of the affected joint, symptoms to watch for, and any activity restrictions.

You may be asked to rest the joint for several hours right after the procedure.

Some mild swelling and fullness may be noted in or around the joint. Your doctor may suggest that you apply ice if swelling occurs. If swelling continues or increases after a day or two, contact the doctor.

Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

After a knee arthrogram, the affected knee may be wrapped with an elastic bandage for several days. You will be shown how to apply the bandage and remove it for bathing and dressing.

You may notice some clicking or cracking noises with movement of the joint for a few days after the procedure. This is normal, and should resolve within a few days.

Tell your doctor if you have any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the injection site
  • Increased pain around the injection site

You may resume your normal diet unless your doctor tells you differently.

Your doctor may give you other instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:
  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure