Role of imaging in spine, hand, and wrist osteoarthritis

Intrarater reliability test of the ISOmetric power device-A new instrument for assessment of isometric force in six directions of wrist motion

STUDY DESIGN

Descriptive reliability study.

INTRODUCTION

A well-functioning wrist requires sufficient range of motion accompanied by adequate strength in every movement and direction-factors that are not regularly measured simultaneously in patients with wrist problems today. The ISOmetric Power device (ISOP) is a new instrument that measures isometric wrist force in all six directions of motion, but its intrarater reliability in a healthy population has not yet been evaluated.

PURPOSE OF THE STUDY

The purpose of this study was to perform an intrarater reliability test of the ISOP in healthy participants.

METHODS

Thirty-two healthy study participants (16 women/16 men; mean age 38.3 years; SD 6.5) were included. With a standardized testing protocol, the three planes of wrist motion- wrist flexion/extension, radial/ulnar deviation, pro/supination-were measured at one time interval (T1) and repeated after one week (T2). The results were analyzed using the intraclass correlation coefficient (ICC). A paired-samples t-test was also performed to determine if a statistically significant difference (P < .05) existed between the first and the second test values. Measurements with Jamar Dynamometer were performed at both time intervals, for internal control of measurement intrarater reliability.

RESULTS

Excellent correlations (ICC: 0.90-0.99) were found for all test-retests performed. The lowest value (ICC: 0.90) was seen for supination and the highest value (ICC: 0.99) for flexion of the left hand. No statistically significant differences were found in any of the pairs (P > .05) in terms of test-re-test, which additionally strengthen the correlation between the first and second test values.

DISCUSSION

Contrary to the Jamar Dynamometer, the ISOP is not designed for measuring grip strength, but for assessing the isometric muscle force in flexion, extension, pronation, supination, and radial and ulnar deviation. A systematic review has reported a moderate to strong correlation between isometric strength and dynamic performances. Thus, the ISOP is a more complete and applicable instrument for evaluating the functional strength in different directions in the upper extremity.

CONCLUSIONS

The ISOmetric Power device shows excellent intrarater reliability and is proposed to be a possible valuable wrist strength assessment tool to aid in both diagnostics and outcome measures of wrist and upper extremity disorders.

Imaging of the Hand and Wrist

Imaging plays a key role in the evaluation and treatment planning of hand and wrist injuries in athletes. Depending on the suspected injury, a combination of conventional radiographs, computed tomography, magnetic resonance imaging, magnetic resonance arthrography, and/or ultrasound may be indicated. This article reviews the strengths and limitations of these imaging modalities and how they can be utilized in commonly encountered clinical questions.

Evaluation of midcarpal capitate contact mechanics in normal, injured and post-operative wrists

BACKGROUND

Scapholunate ligament injury is a commonly occurring carpal ligament injury. Pathology associated with scapholunate ligament injury depends on several factors such as the time after injury, type of injury (instability) and the development of osteoarthritis. The aim of this study was to investigate and compare contact mechanics in the lunocapitate and scaphocapitate joints in the normal, injured (scapholunate dissociation) and repaired (postoperative) wrist.

METHODS

Four human subjects with scapholunate ligament dissociation participated in this study. MR images of normal (contralateral), injured and postoperative wrists were obtained during relaxed condition and during active light grasp. Relaxed MR images were used to construct model geometry (bones with cartilage) for the capitate, lunate and scaphoid. Kinematic transformations were obtained by using image registration between the unloaded and functionally loaded image sets. Joint surface contact mechanics were then calculated.

FINDINGS

All contact measures (contact force, pressure, mean pressure and area) tended to increase with injury in both articulations. A significantly higher contact area was found in the injured scaphocapitate joint compared to normal. A significant increase in peak pressure was observed in the postoperative state compared to normal.

INTERPRETATION

Injury to the scapholunate ligament increased contact measures, suggesting a risk for onset of osteoarthritis in both the scaphocapitate and lunocapitate joints. Surgical repair appeared to restore most measures of contact mechanics to near normal values, more so for the lunocapitate joint when compared to scaphocapitate joint. The elevated postoperative peak pressures indicate the difficulty to fully restore joint mechanics.

Imaging of radial wrist pain. Part II: pathology

Pain on the radial side of the wrist is a common clinical presentation. Such wrist pain may provide a diagnostic challenge for radiologists, in view of the small size of the anatomic structures, the occasional subtlety of the imaging findings, the diversity of potential etiologies, as well as the non-infrequent occurrence of incidental asymptomatic findings in this area. This review discusses the imaging findings in both the more common and less common causes of radial-sided wrist pain, concentrating particularly on the detection of early disease and less readily apparent abnormalities.

The prevalence of osteoarthritis of the atlanto-odontoid joint in adults using multidetector computed tomography

BACKGROUND

The prevalence of osteoarthritis of the atlanto-odontoid joint has been reported by radiology, autopsy, and conventional computed tomography (CT), but the prevalence has not yet been assessed by multidetector computed tomography (MDCT).

PURPOSE

To reveal the prevalence of osteoarthritis of the atlanto-odontoid joint and to analyze the inter-relationships among gender, age, and osteoarthritis with MDCT in adults.

MATERIAL AND METHODS

First, a series of 700 selected domestic patients aged >18 years undergoing an upper cervical MDCT scan were divided equally into seven age groups. Second, using the postprocessing technique of multiplanar reconstruction, osteoarthritis of the atlanto-odontoid joint was viewed from any direction and classified into four grades, which were normal, mild, moderate, and severe. Lastly, the incidence of the different grades of osteoarthritis was assessed, and the reproducibility was tested.

RESULTS

There was no significant difference between gender and osteoarthritis of atlanto-odontoid joint (P > 0.05). The rate of osteoarthritis was 16% in the age group 18-25 years, 23% in the age group 25-30 years, 33% in the age group 30-40 years, 54% in the age group 40-50 years, 70% in the age group 50-60 years, 87% in the age group 60-70 years, and 93% in the age group >70 years. Mild osteoarthritis appeared at the earliest at age 19.6 years, moderate osteoarthritis in at earliest at age 24.2 years, and severe osteoarthritis at the earliest at age 48.5 years. The inter-observer reliability was excellent (k = 0.86).

CONCLUSION

Osteoarthritis of the atlanto-odontoid joint could be detected by MDCT in a young adult. It increased rapidly with increasing age on MDCT.

Long-term clinical results and MRI changes after tendon ball arthroplasty for advanced Kienbock's disease

The purpose of this study was to assess the long-term clinical results and morphological changes after tendon ball arthroplasty for advanced Kienböck's disease. Twenty-six patients were reviewed, with a mean follow-up interval of 125 months (range 50-226). At follow-up, mean score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 7.7 and mean visual analogue scale score for pain was 1. Mean carpal height ratio was significantly reduced with respect to the pre-operative value. On magnetic resonance imaging scans, cartilage damage, synovitis, and erosive or oedematous changes in the bones were detected in most patients. Calcification in the defect filled by the tendon ball was seen in all patients. Narrowing of the radioscaphoid joint and the presence of intercarpal synovitis were negatively associated with clinical outcome. Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes, despite widespread changes in the bones and joints within the wrist.

Osteoarthritis of the spine: the facet joints

Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage.

Osteoarthritis of the spine: the facet joints

Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage.

Comparative study of lumbar magnetic resonance imaging and myelography in young soldiers with herniated lumbar disc

OBJECTIVE

This study was undertaken to compare the diagnostic performances of magnetic resonance imaging (MRI), MR myelography (MRM) and myelography in young soldiers with a herniated lumbar disc (HLD).

METHODS

Sixty-five male soldiers with HLD comprised the study cohort. A visual analogue scale for low back pain (VAS-LBP), VAS for leg radiating pain (VAS-LP), and Oswestry disability index (ODI) were applied. Lumbar MR, MRM, and myelographic findings were checked and evaluated by four independent radiologists, respectively. Each radiologist was asked to score (1 to 5) the degree of disc protrusion and nerve root compression using modified grading systems devised by the North American Spine Society and Pfirrmann and the physical examination rules for conscription in the Republic of Korea. Correlated coefficients between clinical and radiological factors were calculated. Interpretational reproducibility between MRI and myelography by four bases were calculated and compared.

RESULTS

Mean patient age was 20.5 ± 1.1. Mean VAS-LBP and VAS-LP were 6.7 ± 1.6 and 7.4 ± 1.7, respectively. Mean ODI was 48.0 ± 16.2%. Mean MRI, MRM, and myelography scores were 3.3 ± 0.9, 3.5 ± 1.0, and 3.9 ± 1.1, respectively. All scores of diagnostic performances were significantly correlated (p < 0.05). However, none of these scores reflected the severity of patients' symptoms. There was no statistical difference of interpretational reproducibility between MRI and myelography.

CONCLUSION

Although MRI and myelography are based on different principles, they produce similar interpretational reproducibility in young soldiers with a HLD. However, these modalities do not reflect the severity of symptoms.