A practical guide for performing arthrography under fluoroscopic or ultrasound guidance

Abstract

We propose a practical approach for performing arthrography with fluoroscopic or ultrasound guidance. Different approaches to the principal joints of the upper limb (shoulder, elbow, wrist and fingers), lower limb (hip, knee, ankle and foot) as well as the facet joints of the spine are discussed and illustrated with numerous drawings. Whenever possible, we emphasise the concept of targeting articular recesses, which offers many advantages over traditional techniques aiming at the joint space.Teaching Points• Arthrography remains a foremost technique in musculoskeletal radiology• Most joints can be successfully accessed by targeting the articular recess• Targeting the recess offers several advantages over traditional approaches• Ultrasound-guidance is now favoured over fluoroscopy and targeting the recess is equally applicable

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

“…Due to the deep location of the hip, an US-guided injection is preferred over a blind procedure guided by using anatomical landmarks. 3,16 Accuracy rates of US-guided procedures in the hip were reported between 97% and 100% with a few cases of incorrect needle positioning. 17 As in other joints, there is no standard approach to USguided intra-articular injections in the hip.…”

The accuracy of first metatarsophalangeal joint palpation guided injections. An arthrography cadaveric study

“…Most therapeutic injections into joints consist of a glucocorticoid, a local anaesthetic, or a combination of the two, and are widely used in the treatment of foot pathology, in particular for the treatment of osteoarthritis of the rst metatarsophalangeal joint (1 st MTP jt) -hallux limitus/rigidus (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

“…The 1 st MTP jt is a condyloid synovial juncture (26); the metatarso-sesamoid complex consists of the head of the rst metatarsal, the base of the proximal phalanx, two sesamoid bones and associated soft tissue attachments including the tendons, collateral ligaments, and a plantar plate complex (27,28). Injections into the joint can be performed using anatomical (palpation-guided) guided methods (29) or performed with needle placement aided by diagnostic imaging from ultrasound (US) or uoroscopy, with or without the use of contrast media (12,25,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45).…”

Comparison of Ultrasound Guided Deep and Superficial Joint Injections

“…Eklem içi ligamanların rüptürü , osteokondral defektler, impingement, adheziv kapsülit ve loose body tanılarında artrografik yöntemler kullanılmaktadır (4). BT ve MR artrografi gibi tanısal yöntemler için eklem mesafesine kontrast madde enjeksiyonu yapılabilir (5)(6)(7). İntraartiküler enjeksiyon için farklı metodlar bugüne kadar kullanılmıştır.…”

“…İntraartiküler enjeksiyon için farklı metodlar bugüne kadar kullanılmıştır. Bunların arasınd a floroskopi, BT ve ultrasonografi klavuzluğu en yaygın kullanılan yöntemlerdir (5)(6)(7)(8)(9). Görüntüleme yöntemlerinin kılavuzluğu olmadan direkt …”