What are the benefits vs. risks?

Benefits

• Direct arthrography is particularly effective for detecting disease of the structures within the joints such as ligaments, tendons and cartilage. This is particularly true for the shoulder in the setting of shoulder dislocation and in the hip, wrist and elbow.

Exams involving x-ray imaging:

• No radiation remains in a patient's body after an x-ray examination.
• X-rays usually have no side effects in the typical diagnostic range for this exam.

Exams involving MR imaging:

• MRI is a noninvasive imaging technique that does not involve exposure to ionizing radiation.
• MRI enables the discovery of abnormalities that might be obscured by bone with other imaging methods.
• The contrast material used in MRI exams is less likely to produce an allergic reaction than the iodine-based contrast materials used for conventional x-rays and CT scanning.

Risks

• Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• There is always the possibility of injuring a vessel or a nerve adjacent to the joint. Injury to these structures, however, is minimal particularly when the procedure is performed under ultrasound guidance.

Exams involving x-ray imaging:

• There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
• Patients who have known allergies to iodine may have an adverse reaction to the contrast material. Because the contrast material is put in a joint and not a vein, allergic reactions are very rare, although in some cases, mild nausea to severe cardiovascular complications may result.
• Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.
• The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose.

Exams involving MR imaging:

• The MRI examination poses almost no risk to the average patient when appropriate safety guidelines are followed.
• If sedation is used, there are risks of excessive sedation. However, the technologist or nurse will monitor your vital signs to minimize this risk.
• Although the strong magnetic field is not harmful in itself, implanted medical devices that contain metal may malfunction or cause problems during an MRI exam.
• Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of MRI believed to be caused by the injection of high doses of gadolinium-based contrast material in patients with very poor kidney function. Careful assessment of kidney function before considering a contrast injection minimizes the risk of this very rare complication.
• There is a very slight risk of an allergic reaction if contrast material is injected. Such reactions are usually mild and easily controlled by medication. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

What are the limitations of arthrography?

The limitations of arthrography include:

• Partial tears of the rotator cuff may not be detected with conventional direct arthrography.
• Some joint injuries cannot be detected with conventional direct arthrography, including defects of the cartilage, which can be found inside and along the edges of some joints, bruising of neighboring bones and injuries to ligaments outside the joint.