The short answer: an MRI arthrogram is an MRI scan done after a contrast dye called gadolinium is placed inside a joint. The dye fills and stretches the joint so small tears show up more clearly. Most people feel a brief sting from the numbing shot and some pressure, not sharp pain. In studies of hundreds of patients, the injection hurt less than people expected, and any soreness usually faded within a few days.
What is an MRI arthrogram?
An arthrogram is an imaging test of a joint after contrast material is put into it. When the follow-up scan is an MRI, the test is called an MR arthrogram or MR arthrography. The contrast for MRI is gadolinium based, not iodine based, according to RadiologyInfo, the patient site of the American College of Radiology (ACR) and RSNA.
A regular MRI already shows cartilage, tendons, and ligaments well. The contrast pushes the joint lining outward. That separates structures that normally lie flat against each other, such as the labrum (the rim of cartilage around the shoulder and hip sockets) and the joint capsule. Small tears then fill with contrast and stand out.
The ACR practice parameter for shoulder MRI (revised 2024) says MR arthrography may improve accuracy in unstable shoulders. It also lists partial-thickness rotator cuff tears, repeat tears after surgery, and subscapularis tears as cases where it can help. If you want background on how gadolinium works in general, see our guide to MRI with contrast.
What is the difference between direct and indirect MR arthrography?
There are two ways to get contrast into a joint.
- Direct MR arthrography. A radiologist injects dilute gadolinium straight into the joint with a thin needle. This is the version most people mean by "MRI arthrogram." RadiologyInfo notes that direct injection is preferred because it distends the joint and shows small internal structures better.
- Indirect MR arthrography. Gadolinium goes into a vein in your arm, like a standard contrast MRI. It then diffuses across the joint lining. The ACR parameter describes a short delay after the IV injection, during which you may be asked to move or exercise the joint before the scan.
Indirect arthrography avoids a joint needle. The trade-off is that the joint is not stretched, so the effect is weaker. Your radiologist picks the method based on the question your doctor is asking. The rest of this article focuses on the direct method, since that is where the injection question applies.
One fact surprises many patients. The ACR parameter states that putting gadolinium inside a joint is not an FDA-approved use, but it is commonly done without issue. That makes it an off-label use, which is common and accepted in radiology.
How is the contrast injected into the joint?
The injection uses imaging to guide the needle. The ACR parameter notes that ultrasound and fluoroscopy (a live X-ray video) can both be used. The usual steps are:
- You lie on a table and the skin over the joint is cleaned.
- A local anesthetic numbs the skin and the deeper tissue.
- Using fluoroscopy or ultrasound, the radiologist guides a thin needle into the joint space.
- Dilute gadolinium, often mixed with saline and sometimes with an anesthetic, is injected until the joint fills.
- You walk or are moved to the MRI scanner, usually soon after, so the contrast is still in place.
RadiologyInfo says the injection part is usually done within 30 minutes, and an exam that includes the MRI may take more than one hour. For more on scan length, see how long an MRI takes.
The guidance method can matter. A study of 100 shoulder injections at four Dutch centers compared ultrasound and fluoroscopy. The needle reached the joint on the first try in 94% of ultrasound cases versus 72% with fluoroscopy. The ultrasound-guided anterior approach had the lowest pain scores, and ultrasound avoids radiation.
Which joints are imaged with an MR arthrogram?
RadiologyInfo lists the shoulder, elbow, wrist, hip, knee, and ankle. The shoulder and hip are the most common, because labral tears in both joints can be hard to see on a standard MRI. Wrist arthrograms look for tears of the small ligaments and the cartilage disc on the pinky side. Knee arthrograms are used less often, mainly to check a meniscus that was repaired before.
Does the injection hurt?
For most people, it hurts less than they fear. RadiologyInfo describes a slight pinprick and a short burning or sting from the numbing medicine that usually fades in 15 to 20 seconds. You may feel pressure as the needle enters the joint. As the joint fills, a sense of fullness is normal. If you feel pain, tell the radiologist, who can give more anesthetic.
The research backs this up:
- In a Radiology study of 202 people having shoulder MR arthrography, average discomfort from the injection was 16.1 on a 0 to 100 scale. That was lower than the 20.2 people gave to lying in the MRI scanner. More than half (54.4%) said the injection was less uncomfortable than expected. Only 1% said it was worse.
- In a Yale survey of 113 outpatients having arthrograms of the ankle, elbow, hip, knee, shoulder, or wrist, many feared pain and needles beforehand. Afterward, overall pain scores were low, and only 6% found the injection more painful than expected.
Put simply: the needle is usually a short, tolerable part of the visit. For some people, staying still in the scanner is the harder part.
How sore will the joint be afterward?
Some soreness after the test is common. The largest study on this followed 1,085 patients after MR arthrography at a Swiss orthopedic hospital. Its findings:
- Joint pain rose a little after the injection and peaked about 4 hours later.
- Pain scores were back to baseline by one week.
- People younger than 30 reported more pain than older age groups.
- Joint type, contrast volume, sex, and the radiologist's experience did not change pain scores in a significant way.
A randomized shoulder study of 124 patients found that discomfort began right after the procedure and resolved by 48 hours. Pain was higher when the saline used to dilute the contrast contained benzyl alcohol, a preservative. It is reasonable to ask whether your center uses preservative-free saline.
RadiologyInfo advises ice and a mild over-the-counter pain reliever for swelling. It also suggests avoiding vigorous exercise and limiting use of the joint for about 24 hours. Call your doctor if pain or swelling lasts more than two days, or if you get a fever or redness. If you are tracking new joint symptoms in general, symptom.md explains which signs need prompt care.
What are the risks of an MR arthrogram?
Serious problems are rare. The main risks named by RadiologyInfo are:
- Infection. The chance of an infection that needs antibiotics is less than 1 in 1,000. In the 1,085-patient study, no one developed an infection or any other severe side effect.
- Allergic reaction. A reaction to gadolinium is possible but very unlikely. It is usually mild and treatable. Gadolinium causes allergic reactions less often than iodine contrast.
- Nearby nerve or vessel injury. This is possible but minimal, especially with ultrasound guidance.
- Minor side effects. Beyond joint pain, the Swiss study recorded pressure, headache, muscle ache, fatigue, dizziness, and itching.
Tell the team if you are pregnant, have kidney disease, take blood thinners, or had a past reaction to contrast. Bring up any skin infection near the joint, since the needle should not pass through infected skin.
The bottom line
An MRI arthrogram adds a contrast injection into the joint so that small tears in the labrum, ligaments, or cartilage are easier to see. The direct method uses a needle guided by fluoroscopy or ultrasound. The indirect method uses an IV injection and a short wait. The joint shot usually causes a brief sting and pressure, and studies show it is often less uncomfortable than the MRI itself. Mild soreness can peak within hours and is usually gone within a few days. Infection and other serious problems are rare.
Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. Talk with your doctor or radiologist about whether an MR arthrogram is right for your joint and what to expect at your imaging center.