Distal radioulnar joint arthrography

Computed Tomographic Arthrography (Arthroscanner) of the Wrist Joint: Why, How, and When

Background

Acute or chronic wrist pain is a common presentation to a general orthopedic surgeon. The wrist joint is considered one of the most complex articulations in the human body. The complex arrangement of the wrist's intrinsic and extrinsic ligaments and their biomechanics are challenging for the surgeon to diagnose the wrist pathology despite clinical examination. Radiographs, CT scans and MRI are a few modalities that diagnose wrist pathologies efficiently. The accuracy, sensitivity, and specificity in evaluating the chondral, bone, and ligamentous lesion are its limitations. Wrist arthroscopy is considered the reference standard for diagnosing intraarticular pathology of the wrist. Surgical intervention, anesthesia, and the learning curve in wrist arthroscopy are its drawbacks.

Conclusion

CT arthrography is a reliable option for viewing bone anatomy and diagnosing ligamentous tears, cartilage lesions, avulsion injuries, and chondral defects. This review article will discuss surgical anatomy, methods of performing CT arthrography, interpretation of the results, and their advances.

A practical guide for performing arthrography under fluoroscopic or ultrasound guidance

Abstract

We propose a practical approach for performing arthrography with fluoroscopic or ultrasound guidance. Different approaches to the principal joints of the upper limb (shoulder, elbow, wrist and fingers), lower limb (hip, knee, ankle and foot) as well as the facet joints of the spine are discussed and illustrated with numerous drawings. Whenever possible, we emphasise the concept of targeting articular recesses, which offers many advantages over traditional techniques aiming at the joint space.

Teaching Points

• Arthrography remains a foremost technique in musculoskeletal radiology

• Most joints can be successfully accessed by targeting the articular recess

• Targeting the recess offers several advantages over traditional approaches

• Ultrasound-guidance is now favoured over fluoroscopy and targeting the recess is equally applicable

Sonographically guided distal radioulnar joint injection: technique and validation in a cadaveric model

Distal radioulnar joint (DRUJ) disorders are uncommon but important causes of ulnar-sided wrist pain and disability. Fluoroscopically guided injections may be performed to diagnose or treat DRUJ-related pain or as part of a diagnostic arthrogram. Sonographic guidance may provide a favorable alternative to fluoroscopic guidance for distal DRUJ injections. This report describes and validates a sonographically guided technique for DRUJ injections in an unembalmed cadaveric model. An experienced clinician used sonographic guidance to inject diluted colored latex into the DRUJs of 10 unembalmed cadaveric specimens. Subsequent dissection by a fellowship-trained hand surgeon confirmed accurate injections in all 10 specimens. Two cases of ulnocarpal flow, indicative of triangular fibrocartilage injury, were noted during injection and subsequently confirmed during dissection. Clinicians should consider using sonographic guidance to perform DRUJ injections when clinically indicated. Further research should explore the efficacy of sonographically guided DRUJ injections to treat patients with painful DRUJ syndromes or to evaluate the triangular fibrocartilage complex in patients with ulnar wrist pain syndromes.

The relevance of ligament tears or perforations in the diagnosis of wrist pain: an arthrographic study

This study was designed to assess the clinical significance of arthrographic abnormalities in the ligaments of a painful wrist. This was accomplished by means of comparison arthrography of the asymptomatic wrist. Fifty-six consecutive patients with unilateral wrist pain underwent selective bilateral arthrography to assess interruptions of continuity of the triangular fibrocartilage, lunotriquetral, and scapholunate ligaments. The prevalence of bilaterally symmetric lesions was high. In patients with ligament defects in the symptomatic wrist, 88% of defects near the radial attachment of the triangular fibrocartilage, 59% of lunotriquetral defects, and 57% of scapholunate defects were bilateral. Furthermore, physical examination was not predictive of specific ligament defects. This study raises questions concerning the relevance of interrupted ligaments in the diagnosis of wrist pain.

[The diagnostic value of arthrography of the wrist in the evaluation of carpal ligament injuries: radio-surgical correlations. Apropos of 20 cases]

Intra-carpal ligament tears lead to radiocarpal arthritis early diagnosis allows early treatment. Standard and dynamic X rays are not always able to make the diagnosis. In these cases, arthrography of the wrist may give the diagnosis. To establish the specificity of this examination we tried to correlate surgical findings with arthrographic suspicions. Exact diagnosis was established in 12 out of 13 cases of suspected scapholunate ligament tears in 5 out of 6 cases of suspected luno-triquetral ligament tear suspicion and none of the 3 cases of suspected T.F.C.C. rupture suspicion. Wrist arthrography appears to have a good specificity for first row intra-carpal ligament tears. The indication arthrography must be discussed with wrist arthroscopy for the diagnosis of long term wrist pain after clinical examination and standard and dynamic X rays.

Radiographic and orthopedic evaluation of wrist trauma

This paper was written to enable radiologists to contribute more usefully to the diagnosis and treatment of various wrist injuries. All imaging modalities are discussed to equip the radiologist for his difficult task. We present a systematic approach to the evaluation of wrist trauma patients beginning with initial plain films and proceeding through more invasive or sophisticated studies in order to achieve a definitive diagnosis. Toward this end a flow chart has been developed as a quick reference source. The authors have then described the anatomy and kinematics of the wrist to further the radiologist's understanding of the forces involved and the injuries produced by trauma. From this foundation individual injuries are then discussed together with the best methods of making the proper diagnosis of each. Criteria for adequate treatment of various injuries are also presented.

Arthrographic surface anatomy of the carpal triangular fibrocartilage complex

In a review of 364 radiocarpal and 123 distal radioulnar joint arthrograms we identified 44 (12%) patients with contrast defects at either the proximal or distal surface of the carpal triangular fibrocartilage complex (TFCC). Differences in their arthrographic characteristics distinguished two separate groups of patients; one with similar and another with dissimilar appearing TFCC surface contrast collections. Thirty-one of our 44 patients had similar appearing, isolated radial-sided collections at either the proximal or distal TFCC surfaces. Our arthrographic, demographic, and historical study of these patients suggests that the collections are not caused by traumatic partial TFCC tears but represent a normal anatomic variant, probably a synovial recess at the radial TFCC attachment. Arthrography and dissection of a limited number of cadaveric specimens confirmed this conclusion. The second group included the remaining 13 patients. This group had contrast collections at either the proximal or distal TFCC surface, which varied in location and appearance. This smaller group is more likely to represent those uncommon patients with partial TFCC defects caused by tears.