Arthrography of joints

Arthrography is an X-ray method of investigation, during which the joint is examined. The test is performed immediately after the contrast agent is injected into the joint. Sometimes air is also introduced. Often both contrast medium and air are introduced simultaneously. Together they create the possibility of visualizing the contours of the joint structures formed by soft tissues. There is also the possibility of examining the joint surface.

During the procedure, several photographs are taken simultaneously. All is determined by how much movement is carried out in the joint being examined. The method used is called double contrasting.

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Indications for the procedure

Arthrography is recommended to be performed if there is a sustained pain in the joint area. At the same time, the procedure is also shown in the case of a violation of joint functions of an unclear etiology. It can be a bacterial, viral, fungal affection of joints. Also the procedure is carried out with allergic joint damage, in cases of frequent crepitus, injuries in the joints. Indications are various autoimmune lesions of the joint, inflammatory and degenerative processes.

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Preparation

Preparation does not require any specific techniques. The essence of the training is that a person explains the essence of the research, as well as explains its principles, purpose, tasks, and expected results (which the study will presumably show). It is important to tell the person who, where, how to conduct the research.

Preparation does not imply the need for any additional restrictions in the diet, nor in the mode of work and rest. Specific food is also not required. The patient should understand that the essence of the research is that by means of X-ray methods they are examined for the peculiarities of the contrast material moving along the joints. Control that the substance completely filled the joint cavity, and also began to be distributed over the articular tissue. After the substance is completely distributed, X-rays are taken.

 The patient should be warned that local anesthesia is being used. It is advisable to conduct a study in advance for the presence of an allergic reaction. Especially dangerous is an immediate reaction, especially anaphylactic shock. It is also worthwhile to collect anamnesis to predict the possible reactions of the body to the introduction of anesthesia, to a contrast agent.

The patient must be sure to be warned that the study can bring some discomfort, despite the fact that local anesthesia is used. He should understand that the study may be accompanied by a feeling of pain, discomfort, tingling or a feeling of raspiraniya in the area of the joint.

Also, the patient should not move during the study. The number of involuntary movements should also be minimized. A person should not move if the person who conducts the research does not give the appropriate command.

It is also necessary to understand that the patient needs to follow the doctor's instructions clearly, especially if they relate to a change in the position of the body, movements. The instructions should be carried out as quickly and clearly as possible, which will allow to carry out the research as clearly and as quickly as possible.

Do not follow a few days before the study to consume large amounts of liquid, food should be moderate. It should be canceled taking medications containing iodine and its individual components. It is also necessary to warn the physician in advance about the current illnesses, since it is necessary to find out exactly whether the patient has health problems that could in some way complicate the procedure.

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Technique of the arthrography

There are several ways to perform the procedure of X-ray examination of joints by the method of arthrography.

As the first, basic method of arthrographic research, a method is considered in which a contrast agent is injected into the joint cavity. Most often use a contrast containing iodine or other iodine-containing compounds in its composition. This method was called "positive contrast". Air is also used as a contrast agent. In this case, it is a negative contrast.

The second method also considers a method based on a mixture of air and radiopaque material, which simultaneously acts as a positive and negative contrast.

The application of each of the methods has its own distinctive features and its scope. For example, in case of damage to the joint capsule and ligaments, it is advisable to resort to the method of positive contrast. In cases where the meniscus is torn, or a cartilage defect is noted, it is better to use the second method. When examining children, with routine and preventive examination of adults, for a sparing examination of adults and the elderly, this method is also applied. It must be taken into account that sterile conditions are necessary if puncture is necessary.

When fluid is accumulating in the joint bag, it is necessary to pump out this liquid before the introduction of contrast. The amount and size of the intervention depends on the size of the composition. It must be taken into account that the contrast medium is absorbed very quickly. X-ray images should be done immediately after the contrast medium is introduced, otherwise the outline of the image will be fuzzy and blurred.

Technique, the specifics of the procedure can be different. So, depending on the type of research that needs to be done, different techniques of research are used.

Its specificity is, for example, the shoulder method of research, which is used in the diagnosis of muscle cuff rupture. Under the rotator cuff of the shoulder is meant a group of muscles that is located at the highest point of the shoulder. Often, the study of this area is advisable to conduct during the diagnosis of shoulder dislocation. The results of the study make it possible to obtain important diagnostic information about the condition of the joint capsule, as well as the peculiarities of pathological changes in the tendon region of the biceps brachii muscle.

In the study of the knee joint, as the main indication for the study, consider a meniscus injury. This method is very reliable. So, its reliability in detecting injuries is 90%. Also using arthrography, you can diagnose Baker's cysts, which are cyst-like outgrowths that are formed from the synovial fluid and are often localized in the area of the synovial bag. These outgrowths can be formed as a result of the swelling of the synovial membrane against the background of the weakening of the knee joint.

Injuries to the meniscus often occur against a background of chronic polyarthritis or meniscus lesions, weakness of the knee joints. Arthrography makes it possible to diagnose changes and defects in the knee joint area. However, when injuring cartilage and ligaments, this procedure is of little informative.

The ulnar method of diagnosis is a method of diagnosis, which is used when suspicion of rupture of ligaments, as well as the location of articular mice.

The ray-wrist method is a method of diagnosing injuries and ligament ruptures, and is also used for the symptoms of inflammatory processes in the articular ligament.

In the ante-metatarsal form, arthrography is used to diagnose various injuries of the joint capsule. Used for rupturing of external and internal ligaments. Arthrography of the shoulder and knee joint is the method that is most often used in the course of diagnosis.

Examination of other joints has no significant diagnostic value.

Arthrography of the TMJ

Implicit study of the temporomandibular joint. With this form of arthrography, the joints are examined, which consists in creating an artificial contrast of the test cavity and further investigation by X-ray diffraction.

Research is expedient to spend in the morning, on an empty stomach. First, treat the skin around the site of the proposed puncture. Mandatory sanitary and hygienic procedures, antiseptic measures are carried out. Pre-treatment involves washing, removing the hair, and also directly treating the puncture site with an antiseptic. As the main antiseptic agent is used ordinary alcohol. Then local anesthesia is performed in the form of a 1% solution of novocaine. To prevent infection of the joint, penicillin or other antibiotics are administered.

There are three options for conducting studies using the method of arthrography.

In the first case, nitrous oxide or oxygen is blown into the joint cavity. This method is called pneumoarthrography.

In the second case, a heavy high-atomic contrast medium is injected into the joint - this is a method of high-atom arthrography.

In the third case, the method of double joint contrast is used, which implies the introduction of both a gas and a heavy contrast agent into the joint cavity.

After the procedure, they are asked to perform certain movements in the joint, after which the radiography is performed in various projections. If necessary, the method of computed tomography is also used.

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Arthrography of the shoulder joint

When examining the shoulder joint, the joint is treated with the purpose of decontamination. To do this, use antiseptic solutions. Various local anesthetics are injected subcutaneously. In addition, to prevent infection and to reduce the pain threshold, an anesthetic is injected directly into the head of the humerus. To this end, the needle is inserted directly from the joint bag and advances until an articular cartilage is felt.

After removing the Mendrenum, a syringe containing a contrast agent is attached to the needle. Under the control of fluoroscopic techniques, 1 ml of contrast medium is injected into the articular cavity, and the needle is slowly pulled up to it. If the needle is located correctly (and this will be seen on fluoroscopy), then you can enter and the remnants of contrast medium. After that, the needle is slowly removed from the joint, a sterile tampon is used to remove the residues. After the needle is removed, a series of images is quickly taken. This allows you to achieve high image quality and good clarity.

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CT arthrography

Using the methods of computed tomography (or, as it is customarily called CT-arthrography), it is possible to obtain a detailed image of joints prone to contrasting. In this case, the usual traditional method introduces contrast. With this method, small parts and cavities can be examined. It is usually used to investigate small parts that can not be diagnosed with X-rays. The need for a puncture of the contrast medium disappears. Special training is not required.

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MR arthrography

Magnetic resonance method, which is based on the introduction of a contrast agent. This is the most informative method from the entire line of research. This technique allows you to visualize those parts of the joint that can not be examined by other methods of research. For example, this method can diagnose capsules or cavities, various intraarticular and extraarticular surfaces. Used to diagnose, diagnose articular cartilage, meniscus, various inflammatory and infectious diseases.

Arthroscopy

Used primarily to diagnose the condition of large joints. With the help of arthroscopy, the knee, hip, and shoulder joints are examined. It gives an opportunity to reveal various pathological diseases, including inflammatory genesis. With the help of arthroscopy, you can track the parameters in the dynamics. It makes it possible to diagnose pathological changes in the biceps muscle and rotational muscles of the shoulder. In the study of small joints, this method of diagnosis is of little informative.

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Fistulography

This method allows you to evaluate the shape, size, as well as the current state of articular surfaces, soft tissues and bones. Indicators can be evaluated to obtain information about the processes occurring in the dynamics, or in a statics. There are practically no contraindications.

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Contraindications to the procedure

Arthrography is not performed during pregnancy and lactation. It is also advisable to postpone the application of this method of research in the acute stage of arthritis, it is worth waiting for at least the condition in which arthritis from the acute form will move into the normal form.

Contraindication is infectious involvement of joints, violation of blood coagulation processes, skin diseases, external skin and mucous membranes.

Also, the method can be contraindicated with a tendency to allergic reactions. Especially, a strict contraindication is an allergic reaction to iodine and iodine-containing compounds.

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Complications after the procedure

Usually the procedure passes quickly, side effects and negative consequences are rare. Pain may occur during the period of the injection (drug administration), and may persist for some time after the procedure (at least the first 1-2 hours). In exceptional cases, allergic reactions occur, especially if a person has a tendency to hypersensitivity and anaphylaxis.

As the main complications consider the development of inflammatory processes, which arise as a consequence of the intervention. This can be an individual reaction of the body, or a consequence of incorrect or fuzzy administration of the drug. Against the background of increased sensitization of the body, an allergic reaction may develop, the degree of which can vary within a wide range, ranging from allergic rash, burning, irritation, and ending with anaphylactic shock.

If the sanitary and hygienic requirements and aseptic rules are not observed, the infection process, purulent-septic, inflammatory conditions may develop.

Also, complications can be considered crepitating processes, which are accompanied by a sense of crunching, swelling in the implementation of movements in the joint. Also within a few days, there may be a feeling of burning, swelling, swelling in the joint area.

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Care after the procedure

After the end of the procedure, it is necessary to immobilize the joint that was examined. The period of immobilization is 12 hours. In order to ensure the immobility of the joint, apply elastic bandages, bandages. To immobilize the knee joint, a special knee joint is used. Movement after 12 hours should be gradual, easy. To reduce puffiness, ice is applied to the affected area.

If pain occurs, anti-inflammatory or pain medication should be used. If the temperature rises, or a large amount of fluid is released from the joint, you should immediately consult a doctor. Also, with the development of edema, redness, congestion in the area of the injection, immediate medical consultation is also required. Physical activity should be limited for some time. In other respects, arthrography does not require a change in the habitual regimen.

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