Arthrogram (Joint X-Ray)

Why It Is Done

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, before, or as part of 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 problems such as rotator cuff tears.
• 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 thin needle.
• Check needle placement before a painkilling injection, such as a corticosteroid injection.

How To Prepare

Tell your doctor before your arthrogram if you:

• Are or might be pregnant.
• Are allergic to any type of contrast material.
• 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 that says you understand the risks of the test and agree to have it done.

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?).

How It Is Done

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 contrast material (such as dye or air) can be put into the joint. A sample of 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. The 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.

How It Feels

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. Ice packs and nonprescription pain relievers, used as the package directs, may help you feel more comfortable. 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.

What Affects the Test

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

• If you can't 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.

What To Think About

• 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.
  • Magnetic Resonance Imaging (MRI) of the Knee
  • Magnetic Resonance Imaging (MRI) of the Shoulder
  • Arthroscopy
• An arthrogram may be done if other tests, such as MRI, are not available. It also may be done to help your doctor decide whether arthroscopic surgery is needed.
• An arthrogram is usually not done during pregnancy.