MEDRADSC 3C03 Lecture Notes - Lecture 28: Rotator Cuff Tear, Arthrogram, Synovial Joint
14 Jul 2018
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Purpose: to assess the integrity of the synovial joint (often shoulder but other joints are investigated) through the injection of contrast using fluoroscopic guidance. Pain no definitive diagnosis from other modalities, need next level investigation. Simple sterile tray (ie. towels, drape, cleaning forceps, needle driver, cup/bowl for saline) Extension tubing- so hands aren"t right in the way. Needle for injection (superficial joints require a hypodermic needle, deep joints require a spinal needle) If for mri: 1ml syringe for gadolinium 0. 1ml gad diluted in 20ml syringe with saline +/- iodinated contrast. Prior to an arthrogram, routine imaging should be done: plain film x-rays, msk ultrasound. Example: shoulder: ap shoulder, int/external rotation and axillary view. Patient position: supine, external rotation of the shoulder, elevate on pillow: comfortable to reduce motion. Needle insertion: 1cm inferior and 1cm lateral from the coracoid process- place radio opaque marker at this point- check with fluoro. Needle perpendicular to table (20 or 22g 3 1/2 inch needle)
