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Introduction ⬇

An arthrogram, also known as arthrography, involves multiple x-ray examinations of encapsulated joint structures following injection of contrast agents into the joint capsular space. An arthrogram is done in cases of persistent, unexplained joint discomfort. Although the knee is the most frequently studied joint, the shoulder, hip, elbow, wrist, and other joints may also be examined. Local anesthetic agents are used, and aseptic conditions are observed.

Procedure ⬆ ⬇

  1. Position the patient on the examining table.

  2. Surgically prepare and drape the skin around the joint.

  3. Inject a local anesthetic agent into tissues around the joint. It is usually unnecessary to anesthetize the actual joint space.

  4. Aspirate any effusion fluids present in the joint. Inject the contrast agents (e.g., gaseous medium and water-soluble iodinated medium). Remove the needle and manipulate the joint to ensure even distribution of the contrast material. In some cases, ask the patient to walk or exercise the joint for a few minutes.

  5. During the examination, several positions are assumed so as to obtain various x-ray views of the joint.

  6. Pillows and sandbags also may be used to position the joint properly.

  7. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Procedural Alert

If a patient with diabetes is taking metformin, special considerations may be necessary. Consult with the radiology department to determine whether this medication regimen must be discontinued the day of and several days after the study

Clinical Implications ⬆ ⬇

Abnormal joint imaging may reveal the following conditions:

  1. Arthritis

  2. Dislocation

  3. Ligament tears

  4. Rotator cuff rupture

  5. Synovial abnormalities

  6. Narrowing of joint space

  7. Cysts

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test. Advise the patient that some discomfort is normal during contrast injection and joint manipulation.

  2. Obtain a properly signed and witnessed consent form.

  3. Refer to iodine test precautions. Check for known allergies to iodine, other contrast substances, and latex.

  4. Advise the patient to bring any prior x-ray images of the joint in question to the arthrogram appointment.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Tell the patient that the joint should be rested for 12 hours.

  3. Explain that ice can be applied to the area if swelling occurs. Pain can usually be controlled with a mild analgesic.

  4. Warn the patient that cracking or clicking noises in the joint may be heard for 1 or 2 days following the test and that this is normal. Tell the patient to notify the healthcare provider if crepitant noises persist or if increased pain, swelling, or restlessness occurs.

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal

Normal filling of encapsulated joint structures, joint space, bursae, menisci, ligaments, and articular cartilage