Joint Injection/Arthrogram Procedure

What is an arthrogram and how is it done?

An arthrogram is a diagnostic test which examines the inside of a joint (such as hips, shoulders, knees, wrists, ankles) to assess an injury or a symptom you may be experiencing. If your arthrogram is for pain relief, then the pediatric radiology doctor will inject steroids and an anesthetic. 

An MRI arthrogram at Texas Children's Hospital is done in a two-part procedure:

  • First, the pediatric radiology doctor will take pictures using x-rays of the joint before injecting contrast medium (sometimes referred to as a contrast agent or “dye”) which outlines the soft tissue structures in the joint (ligaments and cartilage) and makes them clearer to see on the images or pictures that will be taken of the joint. This may also be done using ultrasound for guidance.
     
  • After the injection, your child will need a magnetic resonance imaging (MRI) to provide more information about what is wrong with the joint.

How do I prepare for an arthrogram?

No specific preparation is required. If your child requires sedation expect a phone call from a nurse the day before the procedure for specific NPO instructions.

In most cases you should have already had at least a plain X-ray of the joint and often an ultrasound, CT scan or MRI. These will be reviewed by our pediatric radiology doctor prior to your arrival.

It’s best to wear comfortable clothing free with any metal with easy access to the joint being examined. You will be asked to change into a hospital gown for some examinations.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.


What happens during an arthrogram?

  • First, a nurse will great and escort you from the waiting room to the prep area for vital signs, health history and pregnancy test if you are female and have started your cycle. If a MRI is ordered, you will be asked to fill out a metal screening sheet. This will ensure that your child can be safely imaged in MRI.

  • The Texas Children's Child Life Department, if necessary, will be present to create a friendly environment.

  • You will be asked to lie down and a numbing skin cream will be applied the skin over the joint being examined. That will stay on for at least 20 minutes for optimal results.

  • You will then be escorted into the Radiology suite. Parents and caregivers over the age of 18 can accompany during the exam.

  • You will lie down on the x-ray table and will be cleaned with an antiseptic solution. More numbing medicine will be injected. Afterward, you will feel pressure but not pain as we perform the arthrogram.

  • A pediatric limited dose x-ray machine or ultrasound will be used to ensure the needle is in the right place before we put contrast dye.

  • Afterward, if an MR arthrogram is to be performed, you will be escorted to MRI for more pictures. You can watch a video through special goggles during the MRI.

  • The x-ray images will take about 10 minutes. The time the needle is in your body is about one minute.

  • The MRI will take about one hour, if applicable.


Will my child be awake for the examination?

In most cases, the children can stay still during the study, in which case they do not need anesthesia or sedation. However, depending upon individual cases, the pediatric radiology doctor may recommend mobile sedation (for a procedure lasting an hour or less) or general anesthesia (for complex procedures generally lasting more than an hour).


How long does an arthrogram take?

The arthrogram itself usually takes about 15 minutes. You may then have to wait a short time before having the scan performed. A subsequent MRI scan may take 30-45 minutes, depending on the joint and the number of scans that have to be done. You should allow approximately 2 hours from arrival at the radiology department.


Are there any after effects of an arthrogram?

Most patients feel some mild to moderate increase in soreness in the joint for 24-48 hours following the injection. Ice packs and nonprescription pain relievers, used as the package directs, may help you feel more comfortable. The joint will then return to feeling the way it was before the examination.


What are the risks of arthrogram?

Arthrograms are safe procedures and complications are unusual. The most serious complication is an infection of the joint (approximately 1 in 300 cases).

If the arthrogram is for pain relief and steroids are used, rare complications also include skin site depigmentation and skin dimpling. These are very rare complications particularly for image guided procedures. Some minor complications include bruising.


What are the benefits of an arthrogram done at Texas Children's Hospital?

Our doctors are pediatric radiology doctors, which means they are trained to treat children; however, they can also treat adults when it comes to joint injections. They are musculoskeletal subspecialty trained pediatric radiology doctors who are experts in orthopedic anatomy of the child. They create a child friendly environment, use special needles, and create an efficient and safe process for your child to have their procedure. 

A MSK coordinator that will call the day before your child’s exam and call the day after to make sure everything is okay.

Our MRI facility has over 100 MSK protocols specifically for pediatric use that is tailored for the size of your child and disease specific. Not all children and diseases are alike and we have special protocols to make sure your child gets the highest quality imaging possible for diagnosis and for presurgical planning if necessary.


Where is an arthrogram done?

At Texas Children’s Hospital, the MSK clinic is located on the fourth floor of the Pavilion for Women (6651 Main Street, Houston, TX 77030). The MRI is done in the same building on the fifth floor.

At Texas Children’s Hospital West Campus (18200 Katy Freeway, Houston, TX 77094), the MSK clinic is located on the second floor. The MRI is also done in the same building and floor.

If your child is recommended to undergo general anesthesia or mobile sedation, then the location will be the fifth floor of the Pavilion for Women. Here, your child will be seen by a nurse practitioner to conduct a screening process prior to undergoing any treatment.


Are there any activity restrictions following the procedure?

Your child should rest the joint for 24 hours and refrain from strenuous activity for a week. If your child has had a steroid injection, then no physical therapy for 48 hours. 


For any pre-procedural or post-procedural questions (such as pain control), please call 832-824-7237 or email MSKradiology@texaschildrens.org for assistance.