Pediatric Arthrography

Arthrography may be done on a joint when there has been persistent and unexplained pain, discomfort, loss of motion or changes in the way the joint works. Other reasons to do this test may include:

• To find problems such as tears in the soft tissues of the joint. These tissues include ligaments, tendons, cartilage and joint capsules.
• To check for damage from repeated dislocations of the joint
• To check prosthetic joints
• To look for synovial or cartilage problems
• To look for an abnormal pathway called a sinus tract that may form after infection
• To look for loose bodies

There may be other reasons for your child's healthcare provider to recommend arthrography.

You may want to ask your child's healthcare provider about the amount of radiation used during the procedure and the risks related to your child's situation. It's a good idea to keep a record of your child's radiation exposure, such as previous CT scans and other types of X-rays, so that you can inform your healthcare provider. Risks linked with radiation exposure may be related to the cumulative number of X-ray exams and/or treatments over a long period.

If your child is allergic or sensitive to medicines, contrast dyes, local anesthesia, iodine or latex, tell their healthcare provider.

Some potential risks of arthrography include:

• Infection and bleeding at the needle site where the contrast dye is injected
• Allergic reaction to the contrast dye. This is rare with direct arthrography because the dye is not injected into a vein

Arthrography is not recommended for children with active arthritis or joint infections.

There may be other risks depending on your child's specific medical condition. Be sure to discuss any concerns with your child's healthcare provider before the procedure.

• Your child's healthcare provider will explain the procedure to you and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
• There is no special restriction on diet or activity before arthrography.
• Be sure to tell your child's healthcare provider if they are sensitive to or are allergic to any medicines, latex, tape, anesthetic agents (local and general), contrast dyes or iodine.
• Tell your child's healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that they are taking.
• Tell your child's healthcare provider if your child has a history of bleeding disorders or if they are taking any anticoagulant (blood-thinning) medicines, aspirin or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
• Based on your child's medical condition, your healthcare provider may give you other instructions on what to do before the procedure.

Arthrography may be done on an outpatient basis or as part of your stay in the hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, arthrography follows this process:

1. Your child will be asked to remove any clothing, jewelry or other objects that might get in the way. A bracelet with your child's name and an identification number may be put on their wrist. Your child may get a second bracelet if they have allergies.
2. When your child is asked to remove their clothing, they will be given a gown to wear.
3. Your child will be positioned on an exam table in the procedure room.
4. X-rays of the joint may be taken before the injection of the contrast dye for comparison with the pictures taken after the dye is injected.
5. The skin around the joint will be covered with sterile drapes and cleaned with an antiseptic solution.
6. The area around the joint will be numbed by using a small needle to inject a local anesthetic (numbing medicine). Your child may feel burning before they feel a numbing sensation.
7. If there is fluid in the joint, this fluid will be removed with a longer needle and syringe.
8. The contrast dye will be injected into the joint using a long, thin needle. Your child may feel pressure as the needle is moved into the joint, but tell the healthcare provider if it hurts your child so more numbing medicine can be used. After this injection, your child may be asked to move the joint so that the dye moves evenly throughout the joint. Your child may be asked to exercise the joint.
9. Once the contrast dye has moved through the joint, multiple X-rays will be taken with the joint in various positions. In some cases, a special frame or traction may be used to stretch the joint for a wider view of the joint. Things like pillows or sandbags may be used to help position the joint. In most cases, your child will get an MRI, or less commonly, a CT, after the arthrogram has been done.

The arthrography procedure itself usually causes minor pain, but having to move or hold the joint still in certain positions might cause some additional discomfort or pain. This is true if your child has recently had surgery or a joint injury. Your child's healthcare provider will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.

Your child's healthcare provider will give specific instructions regarding movement of the joint, pain medicine care of the affected joint, symptoms to watch for, and any activity restrictions.

Your child may be asked to rest the joint for several hours right after the procedure.

Some mild swelling and fullness may be noted in or around the joint. Your child's healthcare provider may suggest that you help your child apply ice if swelling happens. If swelling continues or increases after a day or two, contact your child's healthcare provider.

Give your child a pain reliever for soreness as recommended by their healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

After a knee arthrogram, the affected knee may be wrapped with an elastic bandage for several days. You will be shown how to apply your child's bandage and remove it for bathing and dressing.

You may notice some clicking or cracking noises with movement of the joint for a few days after the procedure. This is normal, and should resolve within a few days.

Tell your child’s healthcare provider if they have any of the following:

• Fever
• Redness, swelling, bleeding or other drainage from the injection site
• Increased pain around the injection site

Your child may resume their normal diet unless their healthcare provider tells you differently.

Your child's healthcare provider may give you other instructions after the procedure, depending on your child's particular situation.