MR Arthrography

Arthrography is MR imaging of the joints after an intra-articular injection of a suitable solution of paramagnetic contrast and saline.

Magnetic resonance arthrography is a great tool and the preferred imaging technique of unstable joints. It is especially useful in the diagnosis of the most complex joints: the shoulder, wrist, hip, the knee joints and the ankle. Magnetic resonance arthrography reliably shows the subtle changes in the joints. It provides valuable information on the scale of damage to the joint elements, thanks to which surgeons get to know what the necessary repairs will be in arthroscopic surgery. Arthrography MRI visualizes structures invisible in other studies – parts of the cartilage of the joints. It is an ideal alternative to invasive diagnostic methods, namely the endoscopic method of imaging (arthroscopy).
Arthrography is particularly useful in evaluating the labrum of the joint, muscle attachments, articular cavity, ligaments, tendons, cartilage and other soft tissues not visible during a standard test.

The test is performed in planes
• transverse
• top
• sagittal

There are two methods of arthrography: direct, where the contrast material is injected into the joint, and indirect, where the contrast is administered intravenously.
In Medical Centers Medici we perform the direct method.
It is a safe, minimally invasive procedure that causes distention of the joint cavity – for better MR imaging.

Course of Examination:

Option A: The patient has only MR arthrography
The initial phase of the Examination: the patient has an MRI of the shoulder joint limited to a few sequences needed to carry out a full assessment of the joint, after the injection of contrast. (15 minutes)

Intermediate phase: the patient goes into the treatment room, where the doctor – a specialist in orthopedics and traumatology – provides a contrast to the joint with a syringe and a long needle. To avoid accidental injection of contrast to the soft tissue thus causing difficulties in the interpretation procedure, it should be performed under the control of X-ray or ultrasound. The procedure is done under local anesthetic – lidocaine. (15 minutes)
For an effective arthrography, MRI with a clear image, the MRI should be performed immediately after the injection of the contrast.

Final phase: after about 30 minutes - the time needed to correct the "wash" of the joint structures with the contrast – the patient returns to the MR to scan after the injection of contrast. Thanks to the contrast all the joint components are shown, especially the broken ones. (about 25 minutes)

Option B: A full scan of the joint and MR arthrography are carried out
The initial phase of the study: the patient has a full MRI with full sequence required. (40 minutes)

Intermediate phase: the patient goes into the treatment room, where the doctor – a specialist in orthopedics and traumatology – provides a contrast to the joint with a syringe and a long needle. To avoid accidental injection of the contrast to the soft tissue thus causing difficulties in the interpretation procedure, it should be performed under the control of X-ray or ultrasound. The procedure is done under local anesthetic – lidocaine. (15 minutes)
For an effective arthrography MRI with a clear image, the MRI should be performed immediately after the injection of the contrast.

Final phase: after about 30 minutes - the time needed to correct the "wash" of the joint structures with the contrast – the patient returns to the MR to scan after the injection of contrast. Thanks to the contrast all the joint components are shown, especially the broken ones. (about 25 minutes)

After the test, the contrast mix is absorbed from the joint cavity without leaving a trace.

During the MRI, the patient is asked to leave outside the laboratory metal objects such as jewelry, glasses, sunglasses, watches, pins, safety pins and bras with metal frame. Before the test, the patient must fill out a questionnaire. There are questions about metal implants or medical electronic devices, e.g. Pacemakers, which are an absolute contraindication to carry out an MRI.

Indications for MR arthrography of the joint:
• damage
• cartilage
• ligaments

The study is particularly recommended in patients with a history of ankle sprain.
The indication for a magnetic resonance arthrography study are damaged cartilage and ligaments. They arise mainly because of injuries in which the shoulder joint is often exposed (in tennis, basketball, gym), knee (skiers) and hip (footballers). This study is particularly recommended in the monitoring of treatment of the meniscus of the knee.

Indications for shoulder arthrography:
evaluation of the integrity of the joint,
instability of the shoulder (evaluation of complex hem-ligament-capsular)
for the diagnosis of hip labrum, acetabular bone damage
evaluation of the adhesion of basic elements to each other
arthritis, pain syndrome, overloaded or stretched tendons, joint degeneration,
damage of the tendon of the long head biceps (SLAP)
damage of the tendons of the rotator cuff

Arthrography of the knee:
Arthrography of the knee is currently the best method to assess the recurrent damage to the meniscus as well as the assessment of treatment after partial removal or repair of the meniscus. MR arthrography may also be useful for the examination of hyaline cartilage in the knees. MR arthrography has been demonstrated to be superior over conventional MRI in assessing the stability of the cartilage and bone fragments of the knee. The presence of intra-articular contrast better shows the size and depth of the defects of articular cartilage and can help with the classification of the damage.

Therefore, MR arthrography of the knee is invaluable in cases of:
- Knee injuries
- Joint damage because of the natural aging process
- Assessment of ligaments and cartilage
- Synovial fluid and joint space

Indications for magnetic resonance arthrography of the knees:
• damage to the meniscus
• Baker's cyst
• changes in the area of the ligaments
• pathological changes of articular cartilage
• osteochondritis
• intra-articular loose bodies
• evaluation of the meniscus after surgery

Indications for MR arthrography of the elbow:
• inflammatory changes
• tumors
• cartilage damage – MR arthrography is the most accurate method

Indications for MR arthrography of the hand:
• a thorough evaluation of the triangular fibrocartilage
• accurate assessment of the ligaments of the wrist

Indications for MR arthrography of the hip:
• evaluation of tumors
• evaluation of inflammatory changes
• assessment of articular labrum
Contraindications for arthrography
Allergy to iodine
Allergy to topical anesthetic

In Medical Centers the Medici we do arthrography of:

- shoulder
- hip
- knee
- elbow
- hand
- joints of the foot

In Medical Centers the Medici, advanced diagnostic imaging of the joints can be performed. During a Magnetic Resonance Study, all research in the field of orthopedics can be performed.

The Department of Orthopedic Surgery deals with injuries and diseases of the musculoskeletal system (bones, joints, ligaments, cartilage, muscles, and nerves).

Patients treated in the department of orthopedic surgery may be hospitalized due to damage or bone fractures, deformities of the spine or ribs, or chronic diseases such as osteoporosis.

Specialist doctors – our orthopedists treat children and adults.
Most orthopedic surgeons work both with patients requiring emergency care and those who have procedures scheduled.

Their diagnostic process usually takes a similar course:
Diagnosis: X-ray, clinical blood tests, other tests
Treatment of trauma
Ordering rehabilitation or physiotherapy to restore fitness, strength and functionality

Some surgeons specialize in the treatment of specific diseases associated with one area of the body.

Orthopedic surgery:

Treatment of fractures
A broken arm, wrist
Fractures knee
Fractures of the collarbone
Hip fracture
Leg fracture
Rib fractures

Arthroscopy - minimally invasive method in which the doctor inserts a tool and a camera with a light source into the joint through a small incision in the skin. The surgical field is visible on a monitor.
Treatment of injured muscles, tendons and ligaments.

Arthroplasty - an operation which consists of replacing or rebuilding a damaged joint usually caused by destructive arthritis. These include ip replacement or knee replacement.

Actions correcting bone deformities - therapeutic procedures aimed at correcting deformities of the spine and ribs.

The Department of Orthopedics at Medical Centers the Medici was created to provide patients with the highest quality of services and to surround them with the best care. The team at the Medici Hospital consists of specialists in surgery of the hand, foot and ankle, hip, knee, shoulder, elbow, spine, and in the fields of sports medicine and trauma. The doctors from our hospital will help you in the event of a sports-related injury, and they will try to remedy the problems associated with the aging process, such as joint destruction as a result of wastage. Our experts will contribute to improving the quality of your life and mobility.

Thanks to the complexity of our offer, we provide patients with full access to postoperative rehabilitation.

Arthritis & replacement of the damaged joint
Pain, swelling and joint stiffness may be due to several reasons which affect the health of joints. In Medical Centers the Medici we perform operations thanks to which the patient stops feeling discomfort associated with the process of the destruction of the joint.
Inflammation of the hip joint
Inflammation of the knee joint
Arthroplasty
Hip replacement

Sports Medicine
Our Sports Medicine Center is dedicated to athletes of all ages. The team at the Medici Sports Center is here to help the patient achieve the highest degree of functionality. The multidisciplinary team consists of experienced orthopedic surgeons, radiologists and physical therapists who specialize in the treatment and rehabilitation of the musculoskeletal system. Our medical center is fully equipped with modern equipment. There is an x-ray, MRI, CT, and physical therapy.

Common conditions treated in the UCSF Sports Medicine Center:
Rotator cuff tears and impingement
Shoulder instability / dislocations
SLAP tears
Shoulder arthritis / Reverse shoulder replacement
Throwing shoulder problems
Athletic elbow problems
ACL and other knee ligament injuries
Meniscus tears
Cartilage injuries in the knee
Patella pain and dislocations
Runner's knee and running problems
Hip labral tears and Femoroacetabular impingement (FAI)
Early arthritis of the hip, knee, and shoulder

General Surgery specializes in surgery of the abdominal cavity organs.

Our surgeons are highly specialized physicians who are mainly engaged in operations of the abdominal cavity, including appendicitis, hernias, gall bladder operations, operations of the stomach and intestines etc. The doctors working in Medical Centers the Medici are well prepared to carry out Operations of general surgery. They use their experience and expertise to make a diagnosis and treat challenging clinical cases. They specialize in laparoscopic surgery.

Our Department of General Surgery is equipped with top-class equipment and protected in the devices to support life. We have Quality Certification from two independent institutions.

Range of services
• One-stop nurse-led clinics for mild disorders of the gastrointestinal tract and upper rectal bleeding
• Direct access to the hernia days Service case
• Vascular scanning and management
• Sentinel node biopsy in the diagnosis of breast cancer
• Established laparoscopic colorectal surgery, including services, cholystetecomy and hernia repair
• Specialist Clinic in diseases of the breast and colon cancer
• Hernia repair (open or laparoscopic)
• Excision / biopsy of the breast lump
• Hemorrhoidectomy
• Laparoscopic cholecystectomy
• Nissen fundoplication / laparoscopic anti-reflux
• Laparoscopic gastric banding for obesity
• Varicose veins
• Anal fistula and anal fissures

What is laparoscopic surgery?
Laparoscopic surgery is also referred to as minimally invasive surgery. Through a small incision in the skin and outer tissues, small tools and a camera with a source of light are introduced to the body cavity. The camera image is transmitted to the screen, which shows organs and tissues. It allows the surgeon to carry out the operation faster, thanks to which the patient is less prone to interference in his body, and it allows faster recovery patient and shorter rehabilitation. Shorter hospital stay, smaller scars, fewer changes in tissues of the body.

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