What is an arthrogram?
An arthrogram (also called arthrography) is a medical imaging procedure that gives healthcare providers a detailed view of what’s happening inside your joints without a single incision. Your provider may use an arthrogram to pinpoint the cause of unexplained joint pain.
Providers may also use arthrography to precisely deliver powerful medication, such as steroids, inside a joint. Healthcare providers call this procedure therapeutic arthrography.
How does an arthrogram work?
Arthrography is a two-part procedure. First, a trained healthcare provider injects a special dye (called contrast) directly or indirectly into the affected joint. The dye absorbs into the joint, making tiny structures (and hard-to-detect problems) easier to see.
Next, a provider takes images of the joint. Your provider may use X-rays, CT, MRI or another type of medical imaging during an arthrogram. In some cases, your provider may take pictures of the joint before and after the dye injection.
What body parts does an arthrogram evaluate?
Arthrograms evaluate the body’s joint tissues. Providers often do this procedure to evaluate your shoulder (called a shoulder arthrogram) or hip (hip arthrogram).
Your provider may recommend an arthrogram to check:
- Shoulder pain, such as from tendonitis or bursitis .
- Hip pain.
- Knee pain.
- Elbow pain, such as from tennis elbow.
- Ankle pain.
- Wrist pain.
Why do healthcare providers perform arthrograms?
Healthcare providers often perform arthrograms to find joint pain’s cause. Your provider may recommend an arthrogram if an initial physical exam or medical tests (such as X-rays) don’t provide enough information for a diagnosis.
Your provider may also recommend an arthrogram if you can’t easily move a joint (such as your knee or shoulder) and don’t know why. Sometimes, medical providers use arthrography to evaluate joint tissues after joint replacement surgery.
What is direct vs. indirect arthrography?
Your provider may perform a direct or indirect arthrogram. During direct arthrography, your provider uses a thin needle to inject dye right into the joint space.
In indirect arthrography, a trained medical professional injects dye into a vein near the affected joint. The dye moves through your blood vessels until it reaches your joint, where dye absorbs into joint tissues.
How should I prepare for an arthrogram?
Your provider will help you understand what to expect during your test. You shouldn’t need to prepare in any special way. If you can, wear loose-fitting clothes that allow you to easily expose the affected joint. You may need to wear a hospital gown during the test.
Each medical imaging technology has risks and benefits. Talk with your provider about your medical history, including any recent illnesses or allergies. Your provider will explain any precautions you may need to take (such as stopping certain medications) before your procedure.
Be sure to tell your physician if you are or think you may be pregnant. Certain tests (such as imaging technologies that use radiation) can harm an unborn baby’s development.
How is an arthrogram performed?
Your provider may ask you to remove your top or pants, depending on which joint you’re having tested.
A radiologist (doctor trained in medical imaging technology) will perform your test. A specially trained technologist may assist in taking medical images. Your providers may take images (such as X-rays) before and after the joint injection.
During an arthrogram, your provider will:
- Position you on a padded table (most likely lying on your back).
- Clean the skin around the joint with an antiseptic solution.
- Drape a cloth over the testing area to show only the affected joint and isolate the testing area.
- Numb the skin and area around the joint with local anesthetic (pain-relieving medication).
- Inject the contrast material directly into or near the joint space.
- Gently move the joint to distribute the dye evenly.
- Remove the needle and clean the injection site.
- Take pictures of the joint using X-rays, MRI or another medical imaging test.
- Move your joint in different positions to get a complete view of joint tissues from various angles.
Providers often perform fluoroscopy and X-ray in the same room where you get the joint injection. If you need a CT or MRI, a medical professional may walk you to another room to get those pictures right after your joint injection.
It’s important to have pictures taken soon after the joint injection. Otherwise, the dye travels throughout your body. Once that happens, medical images no longer provide extra detail around your joint tissues.
During some arthrogram procedures, your provider may inject medication (such as cortisone) right inside your joint. The injection aims to reduce inflammation or relieve pain. The results can give a fuller understanding of joint issues to help detect the problem.
What types of imaging technologies do providers use in arthrography?
Your provider may use one or more imaging tests during your arthrogram:
- X-ray uses a small dose of radiation to take a picture of internal body structures.
- MRI uses a powerful magnet and computer technology to capture detailed, 3D pictures of joint tissues. MRI scans don’t use radiation, which is why some healthcare providers prefer it over other options.
- CT scan uses X-rays and computers to take pictures of your joint from different angles.
- Fluoroscopy uses X-rays to show real-time images of your joint structures on a computer, like watching a movie made of your X-rays.
- Ultrasound uses sound waves (no radiation) to create real-time images on a computer.
Is an arthrogram painful?
Not usually. You may feel slight discomfort when your provider releases the contrast material into the joint. Many people report feeling a “full” or “tight” sensation around the joint.
What should I expect after an arthrogram?
You should be able to get back to your day shortly after the test is over. Some people experience a bit of soreness or swelling around the joint after an arthrogram. If that’s the case, take it easy for the rest of the day.
Any discomfort should go away within two days. If not, call your healthcare provider for guidance.
What are the risks of arthrography?
The overall risks of arthrography are low. Possible risks include:
- Allergic reaction to the contrast material (dye): The risk of having an allergic reaction is low. Tell your provider about any allergies you have before your test. An allergy to the dye used in an arthrogram may cause hives, dizziness or an upset stomach.
- Bleeding or infection: Rarely, people experience complications at the injection site (where the needle went into your skin).
- Radiation exposure: Certain medical imaging technologies (such as X-rays) use small amounts of radiation. Radiation can build up in your body over time and cause health issues. It can also hurt an unborn baby. To minimize your risks, be open with your doctor about your medical history and any chance you may be pregnant.
Results and Follow-Up
When should I know the results of the test?
The radiologist who performed your arthrogram will review the pictures taken of your joint. They will alert your provider to the test results, usually within 24 hours after the test. Results may take longer if you have your test on a Friday.
Your provider will discuss your test results with you. Your provider may recommend more tests or possible treatments (such as joint replacement surgery) to fix the joint and relieve your symptoms.
What should I ask my healthcare provider?
- If you need an arthrogram, you may want to ask your provider:
- Do I need a direct or indirect arthrogram?
- Might I need any other tests?
- What are the risks of this procedure?
- What should I do to prepare for my test?
- When should I expect to get test results?
A note from Cleveland Clinic
Joint pain can keep you from living an active life. But diagnosing joint pain can be tricky. Arthrography offers providers fine details of the tiny structures inside your joints. It’s a relatively painless diagnostic procedure with few risks. If pain in your hip, shoulder or another joint is holding you back, reach out to your provider about tests or treatments that may help you find relief.