Arthrograms are another contrast study done in x-ray, this time of the joints, such as: shoulders, knees, ankles, wrists, etc. This exam is mainly done to see if you have tears or rips in the various connective tissues (tendons, bursa, that sort of thing) that help make up a well working joint. Though MRI is starting to take this study over due to various advantages, including the lack of a need to invade the body with a needle, arthrograms are still being done often enough to warrant being included in any discussion of radiological procedures.

When you report for your arthrogram, the technologist will escort you either to the x-ray room where your exam is to be done, or to a dressing room, depending upon what you are wearing and what joint is to be examined. If the joint in question is covered by your clothing, you will be shown to a dressing room first. Once you are prepared for the study by having the joint properly exposed, you will be introduced to the radiologist and positioned on the x-ray table for the exam. The radiologist will start by cleaning the skin over the joint with betadine and/or alcohol in order to prepare as sterile a field for the exam as possible. He or she will then use lidocaine or a similar medicine to numb the skin over the joint. The next step is to place a needle into the joint using fluoro (short for fluoroscopy) to guide him or her. The radiologist will then inject contrast into the joint, and a series of films, using both fluoro and plain x-rays, will be taken of the joint. Once the radiologist has had a chance to review your x-rays to see if additional views are needed, you will be released. Other than the restrictions your doctor probably already has you on, you will not need to take any additional safety precautions other than to be extra careful in moving the joint just studied until the numbing medicine has worn off. This is for the simple fact that until the numbing medicine has worn off completely, you might not feel it if you accidentally did more damage to the joint.

Probably the most common question I hear in connection with this particular study is "How safe is the x-ray dye you use, and how will you get it out of me?" The answer is very safe, and we don't take it out after the exam. Nowadays most radiology facilities use the newer non-ionic type of contrast media or dye. These dyes have a very low incidence of bad reactions, and, since they are absorbed by the blood stream and then removed from the blood by the kidneys to be passed out of the body with all the other excess fluids, there is no need for us to try to remove the dye following the exam. Indeed, probably the most you will experience from the contrast is a slight flushing sensation and maybe a mild coppery/metallic taste in your mouth as if you had just bit into a penny.

The second most common question I hear about arthrograms is whether the study itself is safe. Personally, I feel this is a very legitimate question considering the fact that this exam involves sticking a needle into the joint. Truthfully, there is some slight risk that the needle insertion could cause a tear in the connective tissue surrounding the joint, just as when you nail two pieces of wood together there is a slight risk that the wood may split. However the risk is really very small since the connective tissues in your body are much stronger in their way than wood. In fact, I've never seen such an injury take place, and I've only heard about it happening twice (and in one of those two cases, the patient had gone to several different doctors and had the study done at least four times inside of one season on the same joint. In this patient's case, I would have been mildly surprised if the injury hadn't occurred.) Still, the risk is there, no matter how slight, and this is the reason that many doctors are ordering MRI studies instead nowadays.

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