Joint X-ray

Joint x-ray is a method of radiation diagnostics that allows to detect pathological changes in bone structures and surrounding periarticular tissues, as well as to track the dynamics of changes in radiological symptoms in various diseases. X-ray signs indicating joint damage may include narrowing or widening of the articular gap, thickening and compaction of soft tissues, calcifications, cystic cleavages of bone tissue, erosion of articular surfaces, osteophytes, violation of normal spatial relationships between the articular head and the cavity, etc. Along with standard joint x-ray, contrast arthrography, pneumoarthrography, as well as computer and magnetic resonance imaging of joints are used in the diagnosis of rheumatic diseases and injuries.

Joint x-ray is based on the ability of tissues of different densities to absorb different amounts of X-rays. Dense bone tissue absorbs a large amount of radiation, soft tissues – insignificant. Using a special device, the radiologist directs a beam of X-rays to the joint. The rays pass through the tissues and form an image on the film located behind the joint. The bone structures of the joint look almost white, the soft tissues have various shades of dark gray.

Joint x-ray is used in traumatology, orthopedics and rheumatology. If indicated, it is used in maxillofacial surgery, oncology and some other areas of medicine. Joint x-ray allows to diagnose fractures, fractures, dislocations, subluxations, arthrosis, arthritis, congenital malformations, metabolic disorders, primary benign and malignant tumors and metastatic lesions of the articular ends of bones in various oncological diseases. With the introduction of air or contrast agents, radiography of joints can be used to detect pathology of cartilage and soft tissues (ligaments, menisci, articular bags).

Indications

An indication for joint x-ray in traumatology is a traumatic injury accompanied by restricted movements, a violation of support, a change in the contours of the joint, hemarthrosis, swelling and cyanosis of soft tissues. The need for joint x-ray is determined individually, taking into account the severity of symptoms, the mechanism of injury and some other factors. As absolute indications for joint x-ray, a rough change in the contours of the joint, springy resistance when trying to move, bone crunch, pathological mobility, sharp restriction of support and movements are considered.

In orthopedics and rheumatology, joint x-ray is indicated for complaints of pain in the joint area, signs of synovitis, the presence of edema and / or deformity, difficulty in support, joint contractures and restricted movements. In oncology, radiography of joints is prescribed in the presence of a tumor-like formation in the joint area (both bone and soft tissue), as well as in case of suspected metastatic lesion of the osteoarticular apparatus. In maxillofacial surgery, joint x-ray is used when traumatic injuries and diseases of the temporomandibular joint are suspected. Indications for joint x-ray in other areas of medicine are systemic diseases, specific and nonspecific infections, endocrine and metabolic disorders accompanied by joint damage.

Pneumoarthrography and contrast arthrography (x-ray of the joint with the introduction of air or contrast agent) are prescribed if damage to the joint capsule, ligament rupture, meniscus rupture, traumatic and non-traumatic cartilage damage is suspected. Most often in clinical practice, contrast-free and contrast studies of large and medium joints of the extremities are required, including radiography of the knee joint, ankle joint, shoulder joint, elbow joint and wrist joint. Less often (in case of injuries, congenital dislocations, arthrosis, arthritis), radiography of the hip joint is used. Radiography of the pubic and sacroiliac joints is usually performed if traumatic pelvic injuries are suspected.

Contraindications

There are no absolute contraindications to conducting contrast-free radiography of joints. Among the relative contraindications are gestation, age under 16 years and high doses of radiation in the anamnesis (during radiation therapy or numerous radiographs). Pregnancy is considered as the most significant contraindication. Women during gestation are prescribed joint x-ray only for vital indications, in other cases, the study is either replaced by other methods, or postponed to a later date (after the end of pregnancy). In the presence of other relative contraindications, the doctor determines the need for joint x-ray individually.

Contraindications to contrast x-ray of joints are hypersensitivity to iodine preparations, acute arthritis, skin diseases and traumatic skin injuries in the joint area, infectious processes in the periarticular soft tissues, blood clotting disorders, arrhythmia, heart disease, increased and decreased blood pressure, severe renal and liver dysfunction. If there are contraindications, patients are referred for CT of the joint, MRI of the joint or arthroscopic examination.

Preparation

No special training is required. Before starting the procedure, the patient is asked to remove clothes and metal objects from the test segment. If the radiography of the joint is performed using air or a contrast agent, the joint is pre-punctured in the treatment room. Then the patient is helped to take the desired position. In some cases, the limb or trunk of the patient is fixed with sandbags, pillows and other devices.

Methodology of conducting

The radiologist directs the X-ray tube to the joint, asks the patient to remain motionless, goes into another room and takes a picture. Then he returns, helps the patient to take a different position and takes a second picture. Standard radiography of joints is carried out in two projections – straight and lateral. Sometimes they additionally perform radiographs in special projections or take a picture of a healthy joint for comparison. The procedure takes about 10 minutes. In emergency cases, X-rays are immediately transferred to the attending physician, and then described, with a routine examination – on the contrary.

Interpretation of results

With the help of this study, it is possible to determine the number, location, degree and direction of displacement of bone fragments in intra-articular and periarticular fractures, to identify violations of the congruence of articular ends in dislocations and subluxations. Joint x-ray is informative for local and widespread decrease or increase in bone density (osteoporosis and osteosclerosis), the presence of intra-articular fluid in hemarthrosis and synovitis, narrowing of the articular gap in arthrosis, expansion of the articular gap in ligament rupture.

Joint x-ray makes it possible to detect deformation of the articular ends of the bone as a result of arthrosis, arthritis or an improperly fused fracture, as well as to identify marginal bone growths and foci of calcification in the soft tissues of the joint (ligaments, joint capsule, synovial membrane, skin, muscles and adipose tissue). In addition, when studying radiographs, you can see neoplasms located in the bones (viewed in detail, you can estimate the size, contours, structure) and surrounding soft tissues (additional CT or MRI studies are required for an accurate assessment).