Developmental dysplasia of the hip. In: Lovell and Winter's Pediatric Orthopedics 5th edn. Renshaw TS. Clin Orthop. Clin Orthop ; Prognostic factors in congenital dislocation of the hip treated with closed reduction. J Pediatr Orthop ; Ponsetti IV.
Lonnerholm T. Arthrography of the hip in children.
What is arthrography?
Acta Radiol Diagn Stockh ; Related articles Arthrography - Developmental dysplasia of the hip. Materials and Me With such criteria, the needle path is distant from the neurovascular bundle. Similar approaches can be used for ultrasound-guided arthrography of the hip [ 18 ]. The knee joint is classically entered via a patellofemoral approach. Alternatively, an anterior approach targeting the anterior recess has been described more recently [ 19 ].
For knee arthrography targeting the anterior recess Fig. The knee of the patient is positioned in slight flexion.
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The target is the lower aspect of the lateral femoral condyle. The joint capacity is more than 40 ml but diagnostic arthrography is appropriately performed with a volume of ml.
What it’s Like to Get an MRI Arthrogram
Anterior approach targeting the lateral femoral condyle as shown on a diagrammatic representation of the knee joint a with a transverse section through the femoral condyles b. When the radiological joint space of the ankle is targeted directly, there is a risk of hitting the anterior tibial margin.
Instead, the anterior recess must be targeted just below the joint line. To do so, the following steps can be performed Fig. The ankle is positioned in slight plantar flexion and the entry point is determined just lateral to the tibialis anterior tendon. The target is just below the joint space. Diagrammatic representation of the ankle joint a with sagittal sections b , c. There is a risk of hitting the anterior tibial margin red dotted line if the radiological joint space is targeted on an anteroposterior view d.
The anterior recess can be targeted just below the radiological joint space e. After needle insertion, the adequate position is confirmed by opacification of the joint space f. Classically, the cervical facet joints are accessed via a lateral, direct approach [ 20 ]. The major disadvantage of this technique is the risk of inadvertent perforation of major vessels and, more rarely, of neural structures [ 20 ].
A posterior approach targeting the articular recess may present a more effective strategy Fig. The technique is as follows:.
The patient is positioned prone with the head rotated opposite to the injected side in order to avoid superimposition of the jaw on the cervical spine. The target is the inferior articular recess of the facet joint, which lies immediately below the most distal aspect of the inferior articular process. We caution against angulating the tube tangential to the facet joint in order to avoid passing through the joint and also to shorten the path. Flow of contrast media away from the needle tip in a horizontal direction with opacification of the joint space confirm adequate position. The joint capacity is about ml.
Diagrammatic representation of the cervical facet joints a with transverse B and sagittal sections C. A lateral approach as represented in blue b , c may lead to perforation of major vessels and dura or nerve root sheaths. A posterior approach targeting the inferior recess as represented in red a , b may be safer because all major neurovascular structures are protected by the articular pillar. The needle is inserted until bone contact and the adequate position is confirmed by opacification of the joint space d. This technique is also advantageous because bilateral injections can be performed without turning the patient and prepping the other side of the neck, as only the head has to be turned.
Arthrography - procedure, pain, complications, infection, nausea, Definition, Purpose, Description
Due to its curved orientation and frequent additional degenerative changes, the joint space is not easily entered via a posterolateral approach under fluoroscopy. It is easier to target the posterior and inferior recess [ 21 ]. For lumbar facet arthrography Fig. The target is the apex of the inferior articular process, which corresponds approximately to the medial and inferior aspect of the pedicle projection.
Flow of contrast media away from the needle tip with opacification of the joint space in a typical ovoid shape confirm adequate position. The main theoretical advantage of the technique is that it facilitates articular injection when the joint space is obscured, either by patient positioning or degenerative changes to the joint. Moreover, reliable depth estimation can be provided by bone contact.
By targeting the articular recess, the needle path is often shorter, thus diminishing the number of structures whose integrity is compromised. In our experience, this approach inflicts less pain to patients. A prerequisite of the technique is a precise anatomical knowledge of the articular recesses.
Also, there is a risk of mixed injection where the contrast medium enters both the intra-articular and extra-articular spaces, especially in the absence of effusion or in the case of smaller joints Fig. Mixed injections usually occur when a shallow recess is approached perpendicularly with a long-bevelled needle.
This risk is reduced by using a short-bevelled needle or by orienting the needle tangentially to the cartilage surface. Better to use a short-bevelled needle d or to direct the needle tangentially to the cartilage e. Ultrasound is used with a steadily growing frequency for guiding joint injections and aspirations as an alternative to fluoroscopy, mainly due to its lack of ionising radiation [ 22 , 23 ].
We have observed that targeting the articular recess can be easily transposed to ultrasound-guided injections. With this technique, the needle should be kept parallel to the transducer to be visible, which makes targeting the recess rather than the joint line easier. A potential drawback of ultrasound-guided arthrography is the limited view of the whole joint and potential communications with neighbouring structures during injection.
We reviewed some of the approaches most commonly performed for arthrography of the principal articulations. These approaches represent only a few of the numerous possibilities, and radiologists should feel free to tailor their own technique in order to safely perform arthrography. By highlighting the capsular anatomy, we emphasised the approaches targeting the recess rather than the apparent joint space.
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This knowledge is also useful when performing ultrasound-guided arthrography, as capsular recesses are directly visible with this modality. National Center for Biotechnology Information , U. Journal List Insights Imaging v. Insights Imaging. Published online Oct Eugen Lungu and Thomas P Moser. Author information Article notes Copyright and License information Disclaimer. Thomas P Moser, Email: ac. Corresponding author. This article has been cited by other articles in PMC.
Abstract Abstract We propose a practical approach for performing arthrography with fluoroscopic or ultrasound guidance. Introduction Arthrography has been an essential technique in musculoskeletal radiology for more than years now and remains useful in combination with computer tomography and magnetic resonance imaging for a detailed assessment of articular structures, or by itself as a way to confirm the adequate distribution of therapeutic injections [ 1 , 2 ].
Open in a separate window. General technique of arthrography The technique varies slightly depending on the articulation and guidance modality, but can be outlined as follows: Positioning of the patient and the articulation The patient is placed in a manner appropriate for the injected joint. Insertion of the needle Ideally, the tip of the needle should be superimposed over the hub on control fluoroscopic images. Confirmation of intra-articular position Under fluoroscopic guidance, contrast medium is generally used to confirm intra-articular location.
Injected substances For therapeutic injections, steroids are most commonly employed. Upper limb Shoulder For arthrography of the glenohumeral joint, an anterior approach targeting the rotator cuff interval can be performed [ 9 ]. Elbow Arthrography of the elbow is commonly performed through the humeroradial compartment Fig.
Wrist The wrist joint compartments are all accessed using a dorsal approach. Fingers and toes Arthrography of the metacarpophalangeal, metatarsophalangeal, and interphalangeal joints can be performed by targeting the dorsal articular recess. Lower limb Hip Because of the anatomical configuration of the coxofemoral joint, the approach for arthrography of the hip necessarily targets the anterior recess.
Knee The knee joint is classically entered via a patellofemoral approach.
Hip Arthrograms: Your Questions Answered!
Ankle When the radiological joint space of the ankle is targeted directly, there is a risk of hitting the anterior tibial margin. Spine Cervical facet joints Classically, the cervical facet joints are accessed via a lateral, direct approach [ 20 ]. The technique is as follows: The patient is positioned prone with the head rotated opposite to the injected side in order to avoid superimposition of the jaw on the cervical spine. Lumbar facet joints Due to its curved orientation and frequent additional degenerative changes, the joint space is not easily entered via a posterolateral approach under fluoroscopy.
Advantages and disadvantages of targeting the articular recess The main theoretical advantage of the technique is that it facilitates articular injection when the joint space is obscured, either by patient positioning or degenerative changes to the joint. Conclusions We reviewed some of the approaches most commonly performed for arthrography of the principal articulations. Compliance with ethical standards Conflicts of interest None. References 1.
Springer, New York. History of arthrography. Radiol Clin N Am. Hodler J.