Author: A/Prof Howard Galloway*

What are the prerequisites for having an arthrogram done?

Generally the patient should have had at least a plain X-ray of the joint and often an ultrasound, CT scan or MRI.

Arthrography (like any test) should only be performed when the additional information obtained has the potential to alter the treatment or provide additional prognostic information when compared to a non-arthrographic or alternate study (e.g. ultrasound for rotator cuff tear).

Specific clinical indications for MR arthrography include the potentially unstable shoulder joint particularly in an athlete.

Diagnosis of rotator cuff tear where surgery is contemplated and ultrasound or plain MRI is non-diagnostic.

Intrinsic wrist ligament or TFCC tears where these would alter management and cannot be adequately demonstrated on non- arthrographic scans.

Suspected hip labral abnormalities where these would alter management and cannot be adequately demonstrated on non-arthrographic scans.

There are many other situations in which scans following arthrography may be helpful and it is often prudent to discuss the clinical problem with the radiologist to obtain advice on the most effective study for the patient’s individual situation.

What are the absolute contraindications for an arthrogram?

  • Infection in or overlying the joint
  • See also contraindications for MRI

What are the relative contraindications for an arthrogram?

Reflex sympathetic dystrophy: Any procedure or minor injury may reactivate or aggravate the symptoms. The Reflex Sympathetic Dystrophy Syndrome Association guidelines recommend the avoidance of all types of even minor procedures on the affected limb (www.rsds.org).

Avascular necrosis of bones adjacent to the affected joint: Anecdotal reports suggest that arthrography aggravates the pain of avascular necrosis.

Anticoagulation: There is no evidence to suggest that arthrography is contraindicated for patients on anticoagulation within the normal therapeutic range.

What are the adverse effects of an arthrogram?

Arthrography is a very safe procedure and complications are unusual.

The most serious complication is an infection of the joint. This is usually caused by organisms from the patient’s skin being transferred into the joint and for this reason the procedure should not be carried out if there is broken or infected skin overlying the joint.

The risk of infection is not precisely know but the best available information suggests that it is in the order of 1 in 40,000.

Occasionally people may be allergic to the contrast medium that is injected and this most commonly results in a rash but may be more serious (see complications of ICCM). The risk of minor reaction (e.g. hives) has been reported at 1:2000. More serious reactions appear to be very rare.

Complications of the MRI contrast medium (gadolinium chelate) have not been reported, probably because of the very small amounts used in arthrography.

Are there alternative imaging tests, interventions or surgical procedures to an arthrogram?

Arthroscopy performed by an orthopaedic surgeon is the most common alternative test to demonstrate joint pathology.

*The author has no conflict of interest with this topic.

Page last modified on 29/3/2017.

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