Vacuum-Assisted Core Biopsy
What is a vacuum-assisted core biopsy? Vacuum-assisted core biopsy is a safe and minimally invasive procedure in which a sample…Read more
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.
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.
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.
Arthroscopy performed by an orthopaedic surgeon is the most common alternative test to demonstrate joint pathology.
Page last modified on 29/3/2017.
RANZCR® is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.