Wrist Arthrography Research Articles

Midcarpal wrist arthrography for detection of tears of the scapholunate and lunotriquetral ligaments

After preliminary scout films, the patient is placed in the supine position with the arm at the side and hand pronated. The midcarpal space is entered between the scaphoid and capitate bones, near the distal end of the scaphoid. This space is easily seen fluoroscopically and is optimally widened with the wrist prone in ulnar deviation (fig. 1A). A metallic marker is centered over the midpoint of the widened space, the skin is marked, and the patient is cautioned to maintain ulnar deviation until the contrast medium injection is made. After sterile skin preparation, a small amount of local anesthesia is administered and a 23-gauge needle is directed perpendicularly into the joint space. A preloaded syringe and venotube with 60% contrast medium is then attached to the needle. The scapholunate and lunotriquetraljoints are kept in view and watched carefully with continuous videotape recording as the injection is made . Usually 3 ml of contrast medium will satisfactorily fill the midcarpal joint spaces. Fluoroscopic monitoring should be continued until the joint spaces are filled (figs. 1B and 2). If monitoring is not continuous at this critical time, contrast medium may leak unobserved through a tear of the scapholunate or lunotriquetral ligament and quickly spread through the radiocarpal space, making a judgment impossible as to which interosseous ligament is disrupted (fig. 2). It is important to obtain standard radiographs as well, since with further manipulation of the wrist by the technologist in positioning, other ligarnentous tears may be revealed. If the midcarpal arthrograrn is normal, a radiocarpal joint injection should then follow, so as not to overlook the possibility of other radiocarpal joint disruption accounting for symptoms.

Wrist Arthrography

Wrist arthrography can be helpful in the evaluation of the chronically painful wrist and, more specifically, in visualization of the integrity of the triangular fibrocartilage and interosseous ligaments. To be meaningful, arthrographic findings, i.e., compartment communication, synovial irregularity, tendon sheath and lymphatic visualization, loose bodies, and cartilage abnormalities, must be correlated with clinical history and physical examination.

Arthrography of the Wrist and Shoulder

SUMMARY Arthrography of the shoulder is an important and accepted technique in the evaluation of shoulder pain. The radiographic findings can often be directly translated into treatment considerations. The role of wrist arthrography is controversial. The radiographic findings are less specific and therefore require more individual interpretation. In our experience, the wrist arthrogram represents a useful adjunctive procedure in the evaluation of unexplained wrist pain.

WRIST ARTHROGRAPHY

Wrist arthrography is an adjunctive procedure that may be valuable to the clinician. Although it is sensitive to particular abnormalities, it lacks the specificity to completely diagnose a given condition. Information gained by arthrography can be used as supportive evidence, in conjunction with clinical and laboratory findings, to aid in the management of individual patients.

Arthrography as a Method of Diagnosing Soft-tissue Injuries of the Wrist

Wrist arthrography was performed in 30 patients suffering from post-traumatic wrist sprain, or whom 15 sustained fractures. A longstanding soft-tissue injury was demonstrated in 70% of the whole group and in 60% of wrist sprains not associated with fracture. Findings include radiocarpal-radionulnar communications (26.6%), radiocarpal-midcarpal communications (36.6%), midcarpal-carpometacarpal communications (30%), radiocarpal-pisotriquetral communications (60%), tendon communications (20%), and lymphatic filling (43.3%).