Chapter 12 Contrast Arthrography 9 25 2014 online ed.
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Transcript of Chapter 12 Contrast Arthrography 9 25 2014 online ed.
Chapter 12Chapter 12
Contrast ArthrographyContrast Arthrography
9 25 2014 online ed.
What is contrast arthrography?What is contrast arthrography?
Radiographic examination of soft tissue Radiographic examination of soft tissue structures of joints after injection of contrast structures of joints after injection of contrast mediamedia
MRI has largely replaced contrast MRI has largely replaced contrast arthrographyarthrography
Noninvasive Noninvasive fewer risks are associatedfewer risks are associated
Contrast MediaContrast Media
AirAirNegative contrastNegative contrast
Iodinated contrastIodinated contrastPositive contrastPositive contrast
KneeKnee
WristWrist
HipHip
ShoulderShoulder
TMJTMJ
What are most common joints investigated using contrast arthrography?
Knee ArthrographyKnee Arthrography
To assesse soft To assesse soft tissue areas of tissue areas of knee jointknee joint
Cruciate ligamentCruciate ligament
Medial and lateral Medial and lateral meniscimenisci
What are menisci?What are menisci?
Two pads of Two pads of cartilaginous tissuecartilaginous tissue
Serve to Serve to disperse weight of body and reduce friction during movement of joint of joint
Procedure IndicationsProcedure Indications
Cartilage, capsular injuriesCartilage, capsular injuries
Ligament or menisci injuriesLigament or menisci injuries
Loose bodiesLoose bodies
Joint ruptureJoint rupture
Baker’s cystBaker’s cyst
Synovial diseaseSynovial disease
Prosthesis checkProsthesis check
ProcedureProcedure
Skin is first cleaned with betadineSkin is first cleaned with betadine
Local anesthetic is introducedLocal anesthetic is introduced
Joint is puncturedJoint is punctured
(synovial fluid may be aspirated and sent for (synovial fluid may be aspirated and sent for analysis)analysis)
Thick, stringy fluid found Thick, stringy fluid found in cavities ofin cavities of synovial synovial jointsjoints
Reduces friction between Reduces friction between articular cartilage and articular cartilage and other tissues in joints other tissues in joints
Lubricates and cushions Lubricates and cushions during movementduring movement
What is synovial fluidWhat is synovial fluid??
ProcedureProcedure cont’dcont’d
Contrast introduced under fluoroscopic guidanceContrast introduced under fluoroscopic guidance
Needle is removed Needle is removed
Pt exercises kneePt exercises knee to distribute contrast to distribute contrast
Pt is then turned prone if Pt is then turned prone if vertical methodvertical method is used is used
Spot radiographs are obtainedSpot radiographs are obtained
Vertical ray methodVertical ray method
Beam shoots Beam shoots down down (or up if using (or up if using fluoroscopy)fluoroscopy)
Limb placed in Limb placed in stress device to stress device to widen side of jt widen side of jt space under space under investigationinvestigation
TypicalTypical Spot films taken under fluoro by Spot films taken under fluoro by RadiologistRadiologist
(Don’t need to learn for midterm)(Don’t need to learn for midterm)
ProneProne3030º lateral anterior obliqueº lateral anterior oblique45º oblique45º oblique60º lateral posterior oblique60º lateral posterior oblique90º lateral90º lateral
Views are then reversed, Views are then reversed, beginning with pt supine to beginning with pt supine to demonstrate lateral meniscusdemonstrate lateral meniscus
Stress is applied to open the Stress is applied to open the joint space during exposurejoint space during exposure
Horizontal ray methodHorizontal ray method
To demonstrate To demonstrate lateral and medial lateral and medial meniscusmeniscus
Same procedure as Same procedure as with with Vertical method Vertical method but with crosstable but with crosstable CR CR (fluoroscopy not possible)(fluoroscopy not possible)
Tear in medial meniscus
Normal
Post-ProcedurePost-Procedure
Overhead radiographs by tech Overhead radiographs by tech may be requested:may be requested:– AP, lateral, tunnel, lateral viewsAP, lateral, tunnel, lateral views
Make sure puncture area is properly bandagedMake sure puncture area is properly bandaged
Pt may experience some discomfort for a couple of Pt may experience some discomfort for a couple of daysdays
Discourage heavy exerciseDiscourage heavy exercise
Hip ArthrographyHip Arthrography
Acetabular region of Acetabular region of pelvis pelvis
What kind of joint is hip?What kind of joint is hip?Diarthrotic- ball and Diarthrotic- ball and socket jointsocket joint
Allows flexion, extension, Allows flexion, extension, abduction, adduction, abduction, adduction, rotationrotation
Hip Arthrography Hip Arthrography cont’dcont’d
Most often performed on children to evaluate hip Most often performed on children to evaluate hip dislocation before treatmentdislocation before treatment
In adults, primarily to check prosthesis dislocation In adults, primarily to check prosthesis dislocation or presence of infectionor presence of infection
Common puncture siteCommon puncture site–¾¾ distal to inguinal crease distal to inguinal crease
and ¾and ¾ lateral to palpated femoral pulse lateral to palpated femoral pulse
ContraindicationsContraindications
InfectionsInfections
Allergy to contrastAllergy to contrast
Bleeding problemsBleeding problems
Hip ProcedureHip Procedure
After preparation, aspiration, and injection, After preparation, aspiration, and injection, pt is supinatedpt is supinated
Joint is gently manipulated after injectionJoint is gently manipulated after injection
Radiographs must be obtained immediately as Radiographs must be obtained immediately as contrast is rapidly absorbedcontrast is rapidly absorbed
RadiographsRadiographs
APAP
Internal and external rotationsInternal and external rotations
Frog lateralFrog lateral
Hip Arthrogram w/ProsthesisHip Arthrogram w/Prosthesis
Hip ArthrogramHip Arthrogram
With “subtraction”
Radiopaque cement can be hard to distinquish from contrast
Pediatric Hip ArthrogramPediatric Hip Arthrogram
TMJ ArthrographyTMJ Arthrography
CT and MRI have largely replacedCT and MRI have largely replaced
TMJ –What kind of joint?TMJ –What kind of joint?Hinge and gliding jtHinge and gliding jt
Useful in diagnosing abnormalities Useful in diagnosing abnormalities of articular diskof articular disk
(Small, oval fibrocartilage located between (Small, oval fibrocartilage located between mandibular condyle and mandibular fossa)mandibular condyle and mandibular fossa)
Indications for Arthrogram of TMJIndications for Arthrogram of TMJ
Subluxation Subluxation ((Incomplete or partial dislocation of Incomplete or partial dislocation of bone in joint)bone in joint)
More indications for performing More indications for performing examexam
Aplasia- (defective development)
Fx
Ankylosis- (stiffness of jt)
Arthritis
TMJTMJ
Shoulder ArthrographyShoulder Arthrography
Indications: Indications:
Rotator cuff or long head Rotator cuff or long head of biceps tearsof biceps tears
Foreign bodiesForeign bodies
Persistent pain or Persistent pain or weaknessweakness
Frozen shoulderFrozen shoulder
Shoulder ArthrograpyShoulder Arthrograpy
Rotator Cuff TearNormal
Wrist ArthrographyWrist Arthrography
IndicationsIndicationsTraumaTraumaPersistent painPersistent painLimitation of motionLimitation of motion
ProcedureProcedureContrast injected into Contrast injected into dorsal wristdorsal wristWrist manipulated to Wrist manipulated to disperse contrast disperse contrast
The EndThe End