Sometimes you may have persistent pain in your shoulder, knee, or other joint. The doctor may have done tests like X-rays, but the cause is still not clear. Has this happened to you? That's when doctors refer you to a special test called an 'arthrogram.' Let's talk about this simply and clearly.
Simply put, what is an arthrogram?
An arthrogram is a special medical test that helps doctors see more closely what's going on inside your joints. It's also called an arthrography.
Think about it, we usually don't see the small potholes on the road clearly, but when they fill with water, we can clearly see the places where those potholes are, right? Well, this is the same thing. In this test, a special 'dye' , which is a 'contrast material' in medical terms, is injected into the joint where you are experiencing pain. When this dye spreads into the joint, tiny cracks and damage to the cartilage that would not be caught by a normal scan can be seen very clearly in the pictures.
In what cases is this test needed?
Your doctor won't just order this test. They'll only consider it if a simple test like an X-ray or a physical exam can't make a diagnosis. An arthrogram is usually recommended in the following cases:
- If you have unexplained joint pain or stiffness: Sometimes a joint hurts, or you can't bend or stretch properly, but it's not clear what's causing it. This can help to look at the delicate tissues inside the joint.
- If you need to inject medicine directly into a joint: Sometimes, it is necessary to inject medicine, such as steroids, directly into a joint to relieve pain. Using arthrogram technology, the needle can be inserted into the joint and the medicine can be injected. This is called 'therapeutic arthrography'.
- Check the condition after joint replacement surgery: This test is also used to check the condition of the surrounding tissues after a joint replacement.
The most common types of joints that undergo this test are:
- Shoulder
- Hip
- Knee
- Wrist
- Ankle
- Elbow
How is the test done?
This is a two-part process.
1. Part One: A trained doctor will insert the special die mentioned earlier into your joint.
2. Part Two: Then, take pictures of that junction.
There are different ways to take these pictures. Your doctor will decide which method to use based on your condition.
- CT scans (Computed Tomography scans)
- Fluoroscopy
- MRI scans (Magnetic Resonance Imaging scans)
- Ultrasound
Sometimes, there are times when I take pictures before and after the die is pierced and compare the two.
How do you prepare before an arthrogram?
There are a few simple things you need to do to prepare for this test. Let's look at this in a table to make it easier to remember.
| What to do | Why is that? |
|---|---|
| Wear comfortable, loose clothing. | This will allow the medical staff to easily reach your incision. You may even be given a hospital gown to wear. |
| Inform if pregnant or suspected | Tests that use radiation can be harmful to the unborn baby. Therefore, it is essential to tell your doctor about this beforehand. |
| Stop taking the medicine as prescribed by the doctor. | You may be asked to stop taking certain medications (e.g., blood thinners) for a few days before the test. Follow your doctor's instructions exactly. |
What happens during the test?
Okay, now let's see what happens after you're taken to the examination room. Knowing this in advance will help you avoid unnecessary fear.
This test is usually performed by a radiologist. First, you will be made to lie down on a table. Then,
1. The skin around the injection site is thoroughly cleaned with an antiseptic solution .
2. Then, cover the surrounding area with a clean cloth so that only the junction is exposed.
3. Now the most important thing. To reduce the pain when the needle is inserted, the skin and tissue around the junction are numbed . A local anesthetic is used for this.
4. After the skin is numb, the special dye is injected into the joint . At this time, you may feel a slight pressure, a "full" feeling, inside the joint.
5. The doctor will gently move your joint back and forth to spread the dye throughout the joint.
6. Then the needle is removed and the area is cleaned.
7. Now is the time to start taking pictures. Using an X-ray, MRI, or CT scan, pictures of the joint will be taken. You can take several pictures of the joint in different positions.
The most important thing is to take pictures as soon as the dye is inserted, otherwise the dye will travel to other parts of the body, and you won't be able to get a clear picture of the junction.
What happens after the test?
You can return to your normal activities shortly after the test. However, some people may experience some mild soreness or swelling around the area where the dye was injected for a day or two. If this happens, it's best to rest for the day.
If this discomfort lasts more than two days, be sure to call your doctor and tell him/her about it.
Are there any risks in this?
Overall, an arthrogram is a very low-risk procedure . However, as with any medical procedure, there are some minor risks.
- Allergic reaction to the dye: This is very rare. If you have any allergies to anything (especially iodine or seafood), tell your doctor ahead of time. If you do have an allergy, you may experience symptoms such as skin rashes and dizziness.
- Bleeding or infection: The risk of bleeding or infection from the needle insertion site is very low.
- Radiation exposure: Tests like X-rays and CT scans expose you to a small amount of radiation. This amount is very small. However, this can be harmful to pregnant women.
If you are pregnant or have even the slightest suspicion that you are pregnant, it is extremely important to tell your doctor about this before the test.
Some frequently asked questions
Is this very painful?
No. The area around the junction is numb, so the needle doesn't hurt much. Most people feel a "tightness" or "fullness" inside the junction as the dye goes in.
When will the report be received?
The radiologist who performed the test will review your images and create a report. The doctor who ordered the test will usually receive the report within 24 hours. He or she will review the report and explain the results to you.
Can I drive a vehicle after the test?
Usually you can. However, sometimes if you are given a sedative to relax you before the test, you will not be allowed to drive. In such cases, you will need to have someone drive you home. So ask your doctor about this in advance.
Joint pain is something that can take away from our ability to function in life. But sometimes it can be difficult to find the cause. An arthrogram can clearly see even the smallest details inside the joint and help to make an accurate diagnosis. So if you're having trouble finding the cause of your joint pain, talk to your doctor about this test.
Take-Home Message
- An arthrogram is a test that uses a special dye to examine the inside of the joint, producing very clear images.
- This is very helpful in determining the exact cause of joint pain that cannot be found through routine tests.
- This is a safe test that usually causes minor discomfort, but does not carry any major risks.
- Before the test, it is imperative to inform the doctor about your allergies, medications you are taking, and pregnancy.
- Don't ignore persistent joint pain. Talk to your doctor about the tests needed for an accurate diagnosis.
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