Fluoroscope Use

Fluoroscopes are an invaluable tool in the treatment of Osteoarthritis of the knee as they provide immediate and vivid internal imagery of the patient-- clearly demonstrating the bony structures and the joint space of the knee. Incorporating guided fluoroscopy and Arthrogram into our intra-articular joint injection program, we not only increase positive outcomes dramatically, but also build in a robust reimbursable component to each and every care plan.

Arthrogram Benefits

Arthogram offers a huge competitive advantage versus other local providers who do not utilize guided fluroscopy regularly. In addition to improving needle placement, the Arthrogram can:

• Visualize loose bodies such as bone fragments that are floating in the synovial fluid. These fragments may cause "catching" and cannot typically be seen on plain film x-ray.
• Determine the volume of synovial fluid inside the knee capsule and allow you to diagnose if there is a synovial fluid deficiency.
• Confirm "capsular integrity" by taking notice of any tears or leaks in the synovial capsule (you will want to include this finding in your arthrogram report).
• Detect motion changes and "patellar involvement" (loss of cartilage on back of patella and patella coming into contact with tibia/femur)

Injection Accuracy Article

Improving Injection Accuracy of the Elbow, Knee, and Shoulder: Does Injection Site and Imaging Make a Difference? A Systematic Review.

Daley EL(1), Bajaj S, Bisson LJ, Cole BJ. – American Journal of Sports Medicine Author information: (1)Section of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison, Chicago, IL 60612, USA.

BACKGROUND: Joint injections and aspirations are used to reduce joint pain and decrease inflammation. The efficacy of these injections is diminished when they are placed inadvertently in the wrong location or compartment. The purpose of this study was to determine whether the use of varying sites or imaging techniques affects the rate of accurate needle placement in aspiration and injection in the shoulder, elbow, and knee.

HYPOTHESES: (1) Accuracy rates of different joint injection sites will demonstrate variability. (2) Injection accuracy rates will be improved when performed with concomitant imaging.

STUDY DESIGN: Systematic review of the literature.

METHODS: Studies reporting injection accuracy based on image verification were identified through a systematic search of the English literature. Accuracy rates were compared for currently accepted injection sites in the shoulder, elbow, and knee. In addition, accuracy rates with and without imaging of these joints were compared.

RESULTS: In the glenohumeral joint, there is a statistically higher accuracy rate with the posterior approach when compared with the anterior approach (85% vs 45%). Injection site selection did not affect accuracy for the subacromial space, acromioclavicular joint, elbow, or knee. The use of imaging improved injection accuracy in the glenohumeral joint (95% vs 79%), subacromial space (100% vs 63%), acromioclavicular joint (100% vs 45%), and knee (99% vs 79%).

CONCLUSION: Injection accuracy rates are significantly higher for the posterior approach compared with the anterior approach for the glenohumeral joint. Similarly, the accuracy rates are also higher when imaging is used in conjunction with injection of the glenohumeral joint, subacromial space, acromioclavicular joint, and knee.

PMID: 21257847 [PubMed – indexed for MEDLINE]1. Am J Sports Med. 2011 Mar;39(3):656-62. doi: 10.1177/0363546510390610. Epub 2011 Jan 21.