Extra-articular hip arthrogram injection (fluroscopic guided)
For anesthetic arthrogram. Hip OA.
Injection of iodinated contrast
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A 22-gauge Quincke needle targets the lateral aspect of the femoral neck. Iodinated contrast has been injected and remains on the lateral aspect of the femoral neck in a linear fashion without extension into the medial aspect. Findings are due to an extra-articular needle tip position with contrast spreading along the extra-articular soft tissues. The needle should be repositioned and then a further injection of contrast is required to confirm an intra-articular needle position.
3 case question available
One of the critical steps in fluoroscopic arthrogram injections is assessing the distribution of the iodinated contrast injection to assess if the needle is in an intra-articular position. It is important to know what a normal and expected spread of contrast into a joint, as once it is confirmed the next injectate is given - whether for MRI, CT or a steroid containing anesthetic arthrogram injectate.
Extra-articular injections often won't 'flow' easily like those in joint and extra-articular injections of iodinated contrast are striated and will not joint contour the joint. Shown is a classic example of an extra-articular injection with contrast spreading along the planes of the soft tissues.