RadteraArthrogram (Fluoro-Guided Joint Injection — Shoulder/Hip/Wrist)
Fluoro+ ContrastMSKverify
Indications
- Pre-MR arthrography for labral tears (shoulder/hip), TFCC and intrinsic ligament tears (wrist)
- Rotator cuff partial tears
- Loose bodies / cartilage assessment (CT arthrogram if MR contraindicated)
- Postoperative joint evaluation
- Therapeutic injection (anesthetic/steroid) often combined
Patient prep
- Screen for contrast/gadolinium allergy, anticoagulation, local infection over puncture site
- Sterile prep and drape; local anesthetic to skin/tract
- Confirm correct joint/side; informed consent
Contrast
AgentMR arthrogram: dilute gadolinium-based contrast (~1:200 to 1:250 dilution; e.g., 0.1 mL Group II GBCA in saline) mixed with iodinated contrast for fluoro confirmation; CT arthrogram: iodinated contrast (e.g., iohexol 300) ± dilution; ± anesthetic ± steroid
Routeintra-articular
DoseShoulder/hip: ~10-15 mL total injectate; wrist: smaller (~3-5 mL); inject 1-2 mL iodinated contrast first to confirm intra-articular position
TimingImage MR within ~90 min (shoulder/hip) or ~45 min (wrist) after injection before contrast resorbs/diffuses
Technique
- Position under fluoroscopy; mark target (shoulder: rotator cuff interval anterior approach or posterior; hip: femoral head-neck junction; wrist: radiocarpal joint dorsal approach)
- Advance spinal/22-25G needle to joint; inject 1-2 mL iodinated contrast under fluoro to confirm intra-articular flow (contrast disperses away from needle, no soft-tissue pooling)
- Once confirmed, inject the dilute gadolinium (MR) or iodinated (CT) mixture to distend the joint
- Capture spot image documenting joint distention
- Transport promptly to MR/CT within the time window
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Localizer / scout | AP of joint | Target landmarks, needle path |
| 2 | Needle position confirmation | AP | 1-2 mL iodinated test injection — confirm intra-articular |
| 3 | Post-injection distention | AP | Documents successful joint filling |
Key points
- Always confirm intra-articular needle position with a small iodinated contrast test injection before injecting gadolinium
- Honor the post-injection time window (shoulder/hip ~90 min; wrist ~45 min) — contrast resorbs and image quality degrades with delay
- For MR arthrogram, gadolinium must be highly diluted (too concentrated causes T1 shortening/signal loss)
- Avoid injection through overlying cellulitis/infection; relative contraindication with significant coagulopathy
- Use sterile technique to avoid septic arthritis; CT arthrogram is the alternative when MR is contraindicated (pacemaker, etc.)
References
• Radiopaedia: Arthrogram (CT) and MR arthrography
• MR Arthrography of the Shoulder, Hip, and Wrist: Contrast Dynamics — AJR (PubMed 17377051)
• Shoulder Arthrogram — StatPearls NBK580562
• ACR–SSR Practice Parameter for Imaging-Guided Arthrography
• MR Arthrography of the Shoulder, Hip, and Wrist: Contrast Dynamics — AJR (PubMed 17377051)
• Shoulder Arthrogram — StatPearls NBK580562
• ACR–SSR Practice Parameter for Imaging-Guided Arthrography
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.