Shoulder Arthrography

Arthrography is a type of imaging which is commonly used to look at the joint such as the shoulder joint and the musculoskeletal system. It's effective at detecting conditions within the ligaments, tendons, and cartilage.  Contrast material can be injected into the bloodstream or directly to the joint which enhances visualisation of the joint space using image guidance.

Procedure

The arthrogram injection’s aim is the painful joint with a contrast solution, but not so distended to cause discomfort. There are two types: CT or MRI arthrography. For direct arthrography, an injection of contrast is carried out under fluoroscopy or CT guidance, although ultrasound guidance can be used. The contrast will depend on whether CT or MRI test is being carried out after the injection. Arthrography is also beneficial for assessing patients after operations.

The surgeon may need to take blood tests or perform a chest x-ray to ensure that the operation can be carried out safely. If you have certain health risks such as certain allergies or blood thinners, more extensive tests may have to be done. Make sure to tell your surgeon if you are taking any medications/supplements. 

CT Arthrography Procedure

The arthrogram injection’s aim is the painful joint with a contrast dye. CT allows a precise visualization of this part of the glenoid, both in cases with acute glenoid fracture and in cases with chronic instability.

MRA Procedure

An MRA exam is a two-part test. First, the arthrogram will be performed. Local anaesthetic will be injected into the joint with the help of either a fluoroscope or a CT scanner to help guide the injection to the right spot. You may feel discomfort or coolness as the contrast is being administered. The MRI will begin after. For more information on this visit our blog post on MRI scanning.

After the Procedure

After the scan, you may be asked to wait to make sure no additional images are needed. Pain and stiffness may be experienced in the shoulder joint for a day or two. Over-the-counter pain relievers may be taken to relieve any discomfort. If the pain remains after two days, contact your doctor.

Risks include infection, bleeding, and allergy. If a local anaesthetic is used, driving is not advised.

References

• Fairfaxradiology.com. 2020. Magnetic Resonance Arthrogram | Fairfax Radiological Consultants. [online] Available at: <https://www.fairfaxradiology.com/procedures/magnetic-resonance-imaging-mri/magnetic-resonance-arthrogram> [Accessed 10 November 2020].

• iRefer Guidelines https://www.irefer.org.uk/guidelines [Accessed 10 November 2020]

• Orthoinfo.aaos.org. 2020. Shoulder Arthroscopy - Orthoinfo - AAOS. [online] Available at: <https://orthoinfo.aaos.org/en/treatment/shoulder-arthroscopy/> [Accessed 10 November 2020].

• Roberts, D., 2020. Arthrogram (MRI) | Radiology Reference Article | Radiopaedia.Org. [online] Radiopaedia.org. Available at: <https://radiopaedia.org/articles/arthrogram-mri?lang=us> [Accessed 10 November 2020]

• Rafii, M., Firooznia, H., Golimbu, C., Minkoff, J. and Bonamo, J., 1986. CT arthrography of capsular structures of the shoulder. American Journal of Roentgenology, 146(2), pp.361-367.

• Sutter, R., 2020. The Role Of CT Arthrography In Shoulder Instability. [online] Available at: <https://www.jbsr.be/articles/10.5334/jbr-btr.1208/> [Accessed 11 November 2020].

• Urmc.rochester.edu. 2020. Arthrography - Health Encyclopedia - University Of Rochester Medical Center. [online] Available at: <https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=92&contentid=P07653> [Accessed 11 November 2020].

• (ACR), R., 2020. Direct Arthrography. [online] Radiologyinfo.org. Available at: <https://www.radiologyinfo.org/en/info.cfm?pg=arthrog> [Accessed 11 November 2020].