Arthrogram (Joint X-ray)

An arthrogram is a test using X-ray and a contrast material (such as a dye, water, air, or a combination of these) to take pictures of a joint. The contrast material is put into your affected joint, which 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, may be 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.

An arthrogram is used to find the cause of ongoing, unexplained joint pain, swelling, or abnormal movement of your joint. It may be done alone or before other tests, such as MRI, CT, or arthroscopy.

An arthrogram is used to:

• Find problems in your joint capsule, ligaments, cartilage (including tears, degeneration, or disease), and the bones in the joint. In your shoulder, it may be used to help find rotator cuff tears and the cause of a frozen shoulder.
• Find abnormal growths or fluid-filled cysts.
• Confirm that a needle has been placed correctly in your joint before joint fluid analysis, a test in which a sample of joint fluid is removed with a long, thin needle.
• Check needle placement before a painkilling injection, such as a corticosteroid injection.

Tell your doctor before your arthrogram if you:

• Are or might be pregnant.
• 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 before the test. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

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

You will be asked to remove any jewelry 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 dye or air can be put into your joint. A sample of your 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. Your 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.

You will feel a prick and sting when the anesthetic is given. You may feel tingling, pressure, pain, or fullness in your joint as the dye is put in.

The X-ray table may feel hard and the room may be cool.

You may have some mild pain, tenderness, and swelling in your joint after the test. You may also hear a grating, clicking, or cracking sound when you move your joint. This is normal and goes away in about 24 hours. If you have ongoing pain, tenderness, or swelling of the joint, tell your doctor.

You can have a few problems from an arthrogram, such as:

• Joint pain for more than 1 or 2 days.
• An allergic reaction to the dye.
• Damage to the structures inside your joint or bleeding in the joint. However, this is very rare because the needle that is used is small.
• Infection in the joint.

There is always a slight risk of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. However, the risk of damage from the X-rays is usually very low compared with the potential benefits of the test.

For example, the radiation exposure from a chest X-ray is about equal to the natural radiation exposure received during a round-trip airline flight from Boston to Los Angeles (Montreal to Vancouver) or ten days in the Rocky Mountains (Denver, Colorado).

An arthrogram is a test using X-ray and a contrast material (such as a dye, water, air, or a combination of these) to take pictures of a joint. The radiologist may discuss the initial results with you after he or she reviews all the pictures. A detailed report will be available to your doctor in a few days.

After your doctor has seen the condition of your joint area, further treatment with medicine, physical therapy, or surgery may be recommended.

Reasons you may not be able to have the test or why the results may not be helpful include:

• If you cannot hold still during the test. The pictures may not be clear.
• If there is a large amount of fluid in your joint. This may affect the spread of the dye and the pictures.

• Magnetic resonance image (MRI) and computed tomography (CT) give different information about a joint. These tests may be used with an arthrogram or when an arthrogram does not give a clear picture. Also, an MRI or arthroscopy may be used before or in addition to an arthrogram to check your joint problem. For more information, see the medical tests Magnetic Resonance Imaging (MRI) of the Knee, Magnetic Resonance Imaging (MRI) of the Shoulder, and Arthroscopy.
• An arthrogram may be done because of cost, insurance coverage, or if other tests, such as MRI are not available. It also may be done to help your doctor decide whether arthroscopy is needed.
• An arthrogram is usually not done during pregnancy.