Article
Shoulder Arthrogram
Dr. Chris Beck • Updated Jan 2, 2024
A shoulder arthrogram is a diagnostic imaging procedure used to assess the structures within the shoulder joint, including the bones, cartilage, tendons, and ligaments. The procedure involves the injection of a contrast dye into the joint space, followed by X-ray or MRI imaging to provide detailed views of the shoulder's internal anatomy. Shoulder arthrograms are often used to diagnose issues such as rotator cuff tears, labral tears, or shoulder instability that may not be visible on standard X-rays. This minimally invasive technique helps doctors accurately identify the root cause of shoulder pain and dysfunction, allowing for more targeted treatment options, including physical therapy, injections, or surgery. The procedure is generally quick and well-tolerated, offering valuable insights into shoulder health and aiding in the development of effective treatment plans.
Table of Contents
Pre Shoulder Arthrogram Procedure Prep
Shoulder Arthrogram Procedure Steps
Post-Procedure
Pre Shoulder Arthrogram Procedure Prep
Indications
• Evaluation for rotator cuff tears and labral injury
• Evaluation of shoulder instability and glenohumeral ligaments
• Adhesive capsulitis of the glenohumeral joint
• Persistent symptoms following surgery
Contraindications
• Infection
Pre-Procedural Evaluation
• Confirm joint and laterality
• Confirm anticoagulation status and history of allergies
• Confirm patient is safe to undergo MRI (pacemaker, spinal stimulator) prior to arthrogram
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Shoulder Arthrogram Procedure Steps
For MRI Arthrogram Shoulder
• Draw up 5 cc contrast into a 20 cc syringe.
• Add 15 cc normal saline to the mixture.
• Can substitute portion of saline for ropivacaine or bupivacaine
• Withdraw 0.1 cc of Gadolinium in 1 cc syringe.
• Add the 0.1 cc of Gadolinium to the contrast mixture in the 20 cc syringe (dilution of 1:200)
Example of Arthrogram Solution
• 20 mL syringe containing: 10 mL saline, 5 mL ropivacaine 0.5%, 5 mL contrast & 0.1 mL Gadavist
Shoulder Arthrogram Procedure
• Position patient supine on the fluoroscopy table with shoulder in neutral or externally rotated position (as tolerated)
• Needle target under fluoroscopy is the rotator cuff interval, which is the upper medial quadrant of the humeral head. Position target in the center of field of view, magnify, and collimate.
• Prep and drape shoulder in sterile fashion.
• Administer 1% local lidocaine along expected course
• Use a straight down vertical approach to contact with the surface of the humeral head with 22-25 gauge needle
• Confirm joint position with injection of 1-2 mL contrast under fluoroscopy.
• When in the joint, contrast will flow away from the needle. If the contrast pools at the needle tip, then needle tip is not in the joint space
• Inject 8-12 mL of the gadolinium mixture into the joint space
• Following injection, remove needle and place bandage
Post-Procedure
Post-Operative Care
• Typically safe for patient to be discharged immediate following MRI or CT
• Educate patient on the signs of infection with instructions to call with any symptoms such as worsening pain or fever
Complications
• Vasovagal episode
• Failure to access joint space resulting in extra-articular contrast
• Infection
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