Joint X-Ray (Arthrogram)

An arthrogram is a test using X-rays to obtain a series of pictures of a joint after a contrast material (such as a dye, water, air, or a combination of these) has been injected into the joint. This allows your doctor to see the soft tissue structures of your joint, such as tendons, ligaments, muscles, cartilage, and your joint capsule. These structures are not seen on a plain X-ray without contrast material. A special type of X-ray, called fluoroscopy, is used to take pictures of the joint.

An arthrogram is used to check a joint to find out what is causing your symptoms or problem with your joint. An arthrogram may be more useful than a regular X-ray because it shows the surface of soft tissues lining the joint as well as the joint bones. A regular X-ray only shows the bones of the joint. This test can be done on your hip, knee, ankle, shoulder, elbow, wrist, or jaw (temporomandibular joint).

Other tests, such as magnetic resonance imaging (MRI) and computed tomography (CT), give different information about a joint. They may be used with an arthrogram or when an arthrogram does not give a clear picture of the joint.

Tell your doctor before your arthrogram if you:

Are or might be pregnant.
Are allergic to any type of contrast material.
Are allergic to iodine. The dye used for an arthrogram may contain iodine.
Are allergic to any medicines, including anesthetics.
Have ever had a serious allergic reaction (anaphylaxis) from any substance, such as a bee sting or eating shellfish.
Have asthma.
Have bleeding problems or are taking blood-thinning medicines.
Have arthritis that is bothering you at the time of your test.
Have a known infection in or around your joint. The dye may make your infection worse.
Have diabetes or take metformin (Glucophage) for your diabetes.
You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

An arthrogram is usually done by a doctor who specializes in interpreting X-rays (radiologist).

You will be asked to remove any jewellery or metal objects from the joint area. You will then sit or lie down with your joint under an X-ray viewer (fluoroscope) that is hooked to a video screen that can show X-ray pictures. The skin over your joint is cleaned with a special soap and draped with sterile towels. A local anesthetic is used to numb the skin and tissues over the joint.

A needle is put into your joint area. Joint fluid may be removed so that more contrast material (such as dye or air) can be put into the joint. A sample of joint fluid may be sent to a lab to be looked at under a microscope. The fluoroscope shows that the needle is placed correctly in your joint. The dye or air is then put through the needle into your joint. The joint may be injected with both dye and air (double-contrast arthrogram). The needle is then removed.

You may be asked to move your joint around to help the dye or air spread inside your joint. Pictures from the fluoroscope show if the dye has filled your entire joint. Hold as still as possible while the X-rays are being taken unless your doctor tells you to move your joint through its entire range of motion. The X-rays need to be taken quickly, before the dye spreads to other tissues around your joint.

If you are having a CT scan or MRI after an arthrogram, a small amount of a medicine called epinephrine may be mixed with the dye to stop the dye from spreading into other tissues.

An arthrogram usually takes about 30 to 60 minutes.

After the arthrogram, rest your joint for about 12 hours. Do not do any strenuous activity for 1 to 2 days. Use ice for any swelling and use pain medicine for any pain. If a bandage or wrap is put on your joint following an arthrogram, you will be told how long to use it.