Semin intervent Radiol 2010; 27(2): 160-171
DOI: 10.1055/s-0030-1253514
© Thieme Medical Publishers

Diagnostic and Therapeutic Joint Injections

Salvatore Masala1 , Roberto Fiori1 , Dario Alberto Bartolucci1 , Matteo Mammucari1 , Giorgios Angelopoulos1 , Francesco Massari1 , Giovanni Simonetti1
  • 1Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, Policlinico Tor Vergata, Rome, Italy
Further Information

Publication History

Publication Date:
18 May 2010 (online)

ABSTRACT

Joint injection is a useful tool in the diagnosis of intra-articular pathology that may improve diagnostic performance of computed tomography (CT) and magnetic resonance (MR) imaging. Historically, conventional arthrography under fluoroscopy was the first method to be used to image indirectly the intra-articular soft tissues, but with the advent of CT, CT arthrography offered better soft tissue depiction. The development of conventional MR allowed even better visualization of soft tissues, and in the early 1990s, MR arthrography surpassed CT arthrography in popularity. Joint injections may also be performed for therapeutic reasons with different drugs, such as corticosteroids, anesthetics, or hyaluronic acid, which have been shown to provide pain relief in various circumstances. In this article, the technical principles for joint injection of the shoulder, knee, elbow, hip, ankle, and wrist, used for therapeutic or diagnostic reasons, are discussed. Indications, expected benefits, and risks are also analyzed.

REFERENCES

  • 1 Steinbach L S, Schneider R, Goldman A B, Kazam E, Ranawat C S, Ghelman B. Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.  Radiology. 1985;  156 303-307
  • 2 Maus T P, Berquist T H, Bender C E, Rand J A. Arthrographic study of painful total hip arthroplasty: refined criteria.  Radiology. 1987;  162 721-727
  • 3 Czerny C, Hofmann S, Neuhold A et al.. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging.  Radiology. 1996;  200 225-230
  • 4 Cotten A, Boutry N, Demondion X et al.. Acetabular labrum: MRI in asymptomatic volunteers.  J Comput Assist Tomogr. 1998;  22 1-7
  • 5 Lecouvet F E, Vande Berg B C, Malghem J et al.. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips.  AJR Am J Roentgenol. 1996;  167 1025-1028
  • 6 Lyons J C, Peterson L FA. The snapping iliopsoas tendon.  Mayo Clin Proc. 1984;  59 327-329
  • 7 Cardinal E, Buckwalter K A, Capello W N, Duval N. US of the snapping iliopsoas tendon.  Radiology. 1996;  198 521-522
  • 8 Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings.  AJR Am J Roentgenol. 2001;  176 67-73
  • 9 Idjadi J, Meislin R. Symptomatic snapping hip: targeted treatment for maximum pain relief.  Phys Sportsmed. 2004;  32 25-31
  • 10 White R A, Hughes M S, Burd T, Hamann J, Allen W C. A new operative approach in the correction of external coxa saltans: the snapping hip.  Am J Sports Med. 2004;  32 1504-1508
  • 11 Jacobson T, Allen W C. Surgical correction of the snapping iliopsoas tendon.  Am J Sports Med. 1990;  18 470-474
  • 12 Brignall C G, Stainsby G D. The snapping hip. Treatment by Z-plasty.  J Bone Joint Surg Br. 1991;  73 253-254
  • 13 Malfair D. Therapeutic and diagnostic joint injections.  Radiol Clin North Am. 2008;  46 439-453, v
  • 14 Blankenbaker D G, Tuite M J. The painful hip: new concepts.  Skeletal Radiol. 2006;  35 352-370
  • 15 Duc S R, Hodler J, Schmid M R et al.. Prospective evaluation of two different injection techniques for MR arthrography of the hip.  Eur Radiol. 2006;  16 473-478
  • 16 Qvistgaard E, Kristoffersen H, Terslev L, Danneskiold-Samsøe B, Torp-Pedersen S, Bliddal H. Guidance by ultrasound of intra-articular injections in the knee and hip joints.  Osteoarthritis Cartilage. 2001;  9 512-517
  • 17 Carson B W, Wong A. Ultrasonographic guidance for injections of local steroids in the native hip.  J Ultrasound Med. 1999;  18 159-160
  • 18 Brossmann J, Preidler K W, Daenen B et al.. Imaging of osseous and cartilaginous intraarticular bodies in the knee: comparison of MR imaging and MR arthrography with CT and CT arthrography in cadavers.  Radiology. 1996;  200 509-517
  • 19 De Filippo M, Bertellini A, Pogliacomi F et al.. Multidetector computed tomography arthrography of the knee: diagnostic accuracy and indications.  Eur J Radiol. 2009;  70 342-351
  • 20 Altman R D, Moskowitz R. Hyalgan Study Group . Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial.  J Rheumatol. 1998;  25 2203-2212
  • 21 Lohmander L S, Dalén N, Englund G Hyaluronan Multicentre Trial Group et al. Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial.  Ann Rheum Dis. 1996;  55 424-431
  • 22 Bliddal H. Placement of intra-articular injections verified by mini air-arthrography.  Ann Rheum Dis. 1999;  58 641-643
  • 23 Jackson D W, Evans N A, Thomas B M. Accuracy of needle placement into the intra-articular space of the knee.  J Bone Joint Surg Am. 2002;  84-A 1522-1527
  • 24 Freiberger R H, Pavlov H. Knee arthrography.  Radiology. 1988;  166 489-492
  • 25 Binkert C A, Zanetti M, Gerber C, Hodler J. MR arthrography of the glenohumeral joint: two concentrations of gadoteridol versus Ringer solution as the intraarticular contrast material.  Radiology. 2001;  220 219-224
  • 26 Cerezal L, Abascal F, Canga A, García-Valtuille R, Rolón A. [Magnetic resonance arthrography indications and technique (II). Lower limb].  Radiologia. 2006;  48 357-368
  • 27 Cerezal L, Llopis E, Canga A, Rolón A. MR arthrography of the ankle: indications and technique.  Radiol Clin North Am. 2008;  46 973-994, v
  • 28 Resnick D. Radiology of the talocalcaneal articulations. Anatomic considerations and arthrography.  Radiology. 1974;  111 581-586
  • 29 Mitchell M J, Bielecki D, Bergman A G, Kursunoglu-Brahme S, Sartoris D J, Resnick D. Localization of specific joint causing hindfoot pain: value of injecting local anesthetics into individual joints during arthrography.  AJR Am J Roentgenol. 1995;  164 1473-1476
  • 30 Cui Q, Milbrandt T, Millington S, Anderson M, Hurwitz S. Treatment of posttraumatic adhesive capsulitis of the ankle: a case series.  Foot Ankle Int. 2005;  26 602-606
  • 31 Lui T H, Chan W K, Chan K B. The arthroscopic management of frozen ankle.  Arthroscopy. 2006;  22 283-286
  • 32 Probyn L J, White L M, Salonen D C, Tomlinson G, Boynton E L. Recurrent symptoms after shoulder instability repair: direct MR arthrographic assessment—correlation with second-look surgical evaluation.  Radiology. 2007;  245 814-823
  • 33 Palmer W E, Brown J H, Rosenthal D I. Labral-ligamentous complex of the shoulder: evaluation with MR arthrography.  Radiology. 1994;  190 645-651
  • 34 Meister K, Thesing J, Montgomery W J, Indelicato P A, Walczak S, Fontenot W. MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation.  Skeletal Radiol. 2004;  33 136-141
  • 35 Rand T, Freilinger W, Breitenseher M et al.. Magnetic resonance arthrography (MRA) in the postoperative shoulder.  Magn Reson Imaging. 1999;  17 843-850
  • 36 Catalano O A, Manfredi R, Vanzulli A et al.. MR arthrography of the glenohumeral joint: modified posterior approach without imaging guidance.  Radiology. 2007;  242 550-554
  • 37 DeMouy E H, Menendez Jr C V, Bodin C J. Palpation-directed (non-fluoroscopically guided) saline-enhanced MR arthrography of the shoulder.  AJR Am J Roentgenol. 1997;  169 229-231
  • 38 Schneider R, Ghelman B, Kaye J J. A simplified injection technique for shoulder arthrography.  Radiology. 1975;  114 738-739
  • 39 Dépelteau H, Bureau N J, Cardinal E, Aubin B, Brassard P. Arthrography of the shoulder: a simple fluoroscopically guided approach for targeting the rotator cuff interval.  AJR Am J Roentgenol. 2004;  182 329-332
  • 40 Farmer K D, Hughes P M. MR arthrography of the shoulder: fluoroscopically guided technique using a posterior approach.  AJR Am J Roentgenol. 2002;  178 433-434
  • 41 Cicak N, Matasović T, Bajraktarević T. Ultrasonographic guidance of needle placement for shoulder arthrography.  J Ultrasound Med. 1992;  11 135-137
  • 42 Valls R, Melloni P. Sonographic guidance of needle position for MR arthrography of the shoulder.  AJR Am J Roentgenol. 1997;  169 845-847
  • 43 Buchbinder R, Green S, Forbes A, Hall S, Lawler G. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial.  Ann Rheum Dis. 2004;  63 302-309
  • 44 Timmerman L A, Schwartz M L, Andrews J R. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation.  Am J Sports Med. 1994;  22 26-31 discussion 32
  • 45 Nakanishi K, Masatomi T, Ochi T et al.. MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.  Skeletal Radiol. 1996;  25 629-634
  • 46 Braun H, Kenn W, Schneider S, Graf M, Sandstede J, Hahn D. [Direct MR arthrography of the wrist- value in detecting complete and partial defects of intrinsic ligaments and the TFCC in comparison with arthroscopy].  Rofo. 2003;  175 1515-1524
  • 47 Brown R R, Fliszar E, Cotten A, Trudell D, Resnick D. Extrinsic and intrinsic ligaments of the wrist: normal and pathologic anatomy at MR arthrography with three-compartment enhancement.  Radiographics. 1998;  18 667-674
  • 48 Linkous M D, Gilula L A. Wrist arthrography today.  Radiol Clin North Am. 1998;  36 651-672
  • 49 Grainger A J, Elliott J M, Campbell R S, Tirman P F, Steinbach L S, Genant H K. Direct MR arthrography: a review of current use.  Clin Radiol. 2000;  55 163-176
  • 50 Steinbach L S, Palmer W E, Schweitzer M E. Special focus session. MR arthrography.  Radiographics. 2002;  22 1223-1246
  • 51 Zlatkin M B, Rosner J. MR imaging of ligaments and triangular fibrocartilage complex of the wrist.  Magn Reson Imaging Clin N Am. 2004;  12 301-331 vi-vii
  • 52 Beaulieu C F, Ladd A L. MR arthrography of the wrist: scanning-room injection of the radiocarpal joint based on clinical landmarks.  AJR Am J Roentgenol. 1998;  170 606-608

Dario Alberto BartolucciM.D. 

Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy and Nuclear Medicine

Policlinico Tor Vergata, v.le Oxford 81,00133, Rome; Italy

Email: bartolucci.md@gmail.com

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