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Hergár L, Kovács N, Agócs G, Weninger V, Skaliczki G, Lutz E, Hegyi P, Kovács BK, Hetthéssy JR. No Evidence for the Superiority of 3-T Magnetic Resonance Imaging Over 1.5-T Magnetic Resonance Imaging for Diagnosing Wrist Ligamentous Lesions: A Systematic Review and Meta-analysis. Arthroscopy 2024:S0749-8063(24)00335-9. [PMID: 38735416 DOI: 10.1016/j.arthro.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To determine the diagnostic accuracy of native magnetic resonance imaging (MRI) regarding different ligamentous lesions of the wrist and to analyze the influence of technical characteristics, such as field strength, application of fat saturation, 3-dimensional sequences, and wrist coils. METHODS A systematic search was performed using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases. Studies that were published before February 12, 2024, were included. All studies comparing the diagnostic accuracy of native wrist MRI with that of wrist arthroscopy for suspected ligamentous lesions were included. Results were analyzed by anatomic localization and technical aspects of the MRI. To assess the quality of included studies, we used the revised Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS The systematic search revealed 5,181 articles. Thirty-seven studies, reporting 3,893 ligamentous lesions, were eligible for inclusion. The studies displayed heterogeneity in terms of technical conditions, such as field strength, the use of wrist coils, the application of 3-dimensional sequences, and fat saturation. Research methods also varied. Overall sensitivity and specificity were 0.78 (0.66-0.86) and 0.81 (0.70-0.89) for 1.5-T MRI, whereas sensitivity was 0.73 (0.68-0.78) and specificity was 0.90 (0.59-0.98) for 3-T MRI. There was no significant difference between the 2 subgroups (P = .3807 and P = .4248). Sensitivity was 0.82 (0.75-0.87) for triangular fibrocartilage complex lesions, 0.63 (0.50-0.74) for scapholunate ligament tears, and 0.41 (0.25-0.60) for lunotriquetral ligament lesions. Specificity for triangular fibrocartilage complex lesions was 0.82 (0.73-0.89), for scapholunate ligament tears was 0.86 (0.73-0.93), and for lunotriquetral ligament lesions was 0.93 (0.81-0.98). CONCLUSIONS The sensitivity and specificity of MRI are influenced by the anatomic location of the lesion and technical conditions. In terms of diagnostic accuracy, no significant difference was found between 1.5-T and 3-T MRI. LEVEL OF EVIDENCE Level III, systematic review of Level II-III studies.
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Affiliation(s)
- Luca Hergár
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Kovács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Viktor Weninger
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Elmar Lutz
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | | | - Judit Réka Hetthéssy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Research Management Workgroup, Semmelweis University, Budapest, Hungary; Hand Clinic, Budapest, Hungary.
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De Santis S, Cozzolino R, Luchetti R, Cazzoletti L. Comparison between MRI and Arthroscopy of the Wrist for the Assessment of Posttraumatic Lesions of Intrinsic Ligaments and the Triangular Fibrocartilage Complex. J Wrist Surg 2022; 11:28-34. [PMID: 35127261 PMCID: PMC8807093 DOI: 10.1055/s-0041-1729757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Background Magnetic resonance imaging (MRI) has been considered the most appropriate examination for wrist ligament injuries diagnosis, but it frequently fails to assess the intrinsic ligament lesion. Therefore, wrist arthroscopy is required to enhance and define the diagnosis. Purpose We compare the MRI imaging with wrist arthroscopy for intrinsic wrist ligaments (scapholunate [SL] and lunotriquetral [LT]) and triangular fibrocartilage complex (TFCC) injuries detection. Patients and Methods From 2007 to 2014, 532 patients affected by suspected SL, LT, and TFCC posttraumatic ligament injury have been investigated by 1.5-Tesla MRI and wrist arthroscopy. Inclusion and exclusion criteria were adopted. Only for SL ligament injury, the arthroscopic findings of complete (stage IV) and partial (stages I-III) SL ligament injury were compared with MRI findings. Statistical analysis, including sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the diagnostic odds ratio, was used to compare MRI with arthroscopic findings. Results A total of 146 patients were accepted in the study. In 68 cases of arthroscopic SL ligament lesion, MRI confirmed the diagnosis only in 50% of the cases. In partial SL lesions, MRI was positive in 24.3% and in complete SL lesions, MRI was positive in 80.6% of the cases. In 10 cases of arthroscopic LT ligament lesion, MRI was positive in 30.0% of the cases. In 33 patients with arthroscopic TFCC lesion, MRI was positive in 66.7% of the cases. Conclusion 1.5-T MRI demonstrated to fail in confirming the lesion of SL, LP, and TFCC ligaments respectively in 50, 70, and 33.3% of the cases positive at arthroscopy. In complete SL ligament lesion, MRI reaches a higher sensitivity than in partial lesion. Arthroscopy remains the best method to demonstrate the ligament lesion and obtain more information regarding the extent and quality of the ligament damage. Level of Evidence This is a Level II, retrospective comparative study.
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Affiliation(s)
| | | | | | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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A Novel Arthroscopic-assisted Repair of Palmer 1B Triangular Fibrocartilage Complex Tears: Early Results. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bendre HH, Oflazoglu K, van Leeuwen WF, Rakhorst H, Ring D, Chen NC. The Prevalence of Triangular Fibrocartilage Complex Signal Abnormalities on Magnetic Resonance Imaging Relative to Clinical Suspicion of Pathology. J Hand Surg Am 2018; 43:819-826.e1. [PMID: 30172277 DOI: 10.1016/j.jhsa.2018.06.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 05/12/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prevalence of triangular fibrocartilage complex (TFCC) signal changes in patients undergoing magnetic resonance imaging (MRI) of the wrist and its relationship to a clinical suspicion of TFCC pathology. The secondary purpose was to study factors that are associated with TFCC signal changes. METHODS In this retrospective study, we looked for any TFCC signal changes in the reports of MRI findings performed during a 3-year period in 1,134 patients. Demographic characteristics, the categorized indications for MRI, and symptoms at the time of the MRI were also retrieved from the medical records. Patients were divided into 6 groups, based on age, to calculate the proportions of TFCC signal changes in the entire cohort and as an incidental finding among patients without a clinical suspicion of TFCC pathology within each age group. RESULTS A total of 321 patients (28%) had incidental TFCC signal changes. The prevalence among 18- to 30 year-olds was 19%, and increased to 64% in patients older than 70 years. Multivariable logistic regression analysis demonstrated that an increase in age is significantly associated with having TFCC signal changes on MRI in patients who have a low clinical suspicion of TFCC pathology. The rate of incidental TFCC signal changes steadily increases with age. CONCLUSIONS The TFCC signal abnormalities on MRI are more common with increasing age in patients with low clinical suspicion of TFCC pathology. At age 70, more than half of all patients will have TFCC signal changes, and more than 90% are present in patients with a low clinical suspicion of TFCC pathology. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
- Hersh H Bendre
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kamilcan Oflazoglu
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Wouter F van Leeuwen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hinne Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Ochman S, Wieskötter B, Langer M, Vieth V, Raschke MJ, Stehling C. High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary? Arch Orthop Trauma Surg 2017; 137:1443-1450. [PMID: 28808768 DOI: 10.1007/s00402-017-2747-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Indexed: 10/19/2022]
Abstract
INTRODUCTION 3T MRI has become increasingly available for better imaging of interosseous ligaments, TFCC, and avascular necrosis compared with 1.5T MRI. This study assesses the sensitivity and specificity of 3T MRI compared with arthroscopy as the gold standard. PATIENTS AND METHODS Eighteen patients were examined with 3T MRI using coronal T1-TSE; PD-FS; and coronal, sagittal, and axial contrast-enhanced T1-FFE-FS sequences. Two musculoskeletal radiologists evaluated the images independently. Patients underwent diagnostic arthroscopy. RESULTS The classifications of the cartilage lesions showed good correlations with the arthroscopy findings (κ = 0.8-0.9). In contrast to the arthroscopy, cartilage of the distal carpal row was very good and could be evaluated in all patients on MRI. The sensitivity for the TFCC lesion was 83%, and the specificity was 42% (radiologist 1) and 63% (radiologist 2). For the ligament lesions, the sensitivity and specificity were 75 and 100%, respectively, with a high interobserver agreement (κ = 0.8-0.9). DISCUSSION 3T MRI proved to be of good value in diagnosing cartilage lesions, especially in the distal carpal row, whereas wrist arthroscopy provided therapeutic options. When evaluating the surgical therapeutical options, 3T MRI is a good diagnostic tool for pre-operatively evaluating the cartilage of the distal carpal row.
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Affiliation(s)
- Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany. .,Department of Trauma-, Hand- and Reconstructive Surgery, Westfälische Wilhelms University of Muenster, Albert Schweitzer Campus 1, Gebäude W1, 48149, Münster, Germany.
| | - B Wieskötter
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - M Langer
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - V Vieth
- Department of Clinical Radiology, University Hospital, Münster, Germany
| | - M J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, Münster, Germany
| | - C Stehling
- Department of Clinical Radiology, University Hospital, Münster, Germany
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Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review. Arthroscopy 2015; 31:2014-20.e2. [PMID: 26095820 DOI: 10.1016/j.arthro.2015.04.090] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/25/2015] [Accepted: 04/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the diagnostic performance of magnetic resonance imaging (MRI) and clinical provocative tests on injuries to the triangular fibrocartilage complex (TFCC), the scapholunate (SL) ligament, and the lunotriquetral (LT) ligament. METHODS An electronic literature search of articles published between January 1, 2000, and February 28, 2014, in PubMed, Embase, and the Cochrane Library was carried out in April 2014. Only studies of the diagnostic performance of MRI and clinical provocation tests using wrist arthroscopy as the gold standard were eligible for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the extraction and reporting of data. The methodologic quality of the included articles was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The primary outcome measure was the negative predictive value (NPV) of wrist MRI and provocative wrist tests, which was defined as the probability of an intact wrist ligament given a negative investigation. The question was whether negative results of MRI or provocative tests were enough to safely discontinue further investigation with arthroscopy. A minimum NPV of 95% was considered a clinically relevant cutoff value. The secondary outcome measures were the positive predictive value (PPV), sensitivity, and specificity. RESULTS A total of 7 articles (327 patients with MRI and 105 patients with clinical tests) were included in this systematic review. The included articles displayed heterogeneity regarding participants, diagnostic methods, and study design. Seven articles investigated the diagnostic performance of MRI, whereas 1 article investigated clinical testing. The NPVs of MRI were as follows: TFCC, 37% to 90%; SL ligament, 72% to 94%; and LT ligament, 74% to 95%. The NPVs of clinical tests were 55%, 74%, and 94% for the TFCC, SL ligament, and LT ligament, respectively. Only 1 study reached the predetermined cutoff value for the primary outcome measure (NPV ≥95%) but only for MRI of the LT ligament; this study also reached a borderline-cutoff NPV of 94% for MRI of the SL ligament. Another study reached borderline-cutoff NPVs of 94% both for MRI and for clinical tests of the LT ligament. CONCLUSIONS A negative result from MRI is unable to rule out the possibility of a clinically relevant injury to the TFCC, SL ligament, or LT ligament of the wrist. Clinical provocation wrist tests were of limited diagnostic value. The current gold standard--wrist arthroscopy--remains the preferred diagnostic technique with sufficient conclusive properties when it comes to wrist ligament injuries. LEVEL OF EVIDENCE Level II, systematic review of Level II diagnostic studies.
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Affiliation(s)
- Jonny K Andersson
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Daniel Andernord
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Vårdcentralen Gripen, Karlstad, Sweden; Primary Care Research Unit, Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jan Fridén
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden
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7
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Iida A, Omokawa S, Akahane M, Kawamura K, Takayama K, Tanaka Y. Distal radioulnar joint stress radiography for detecting radioulnar ligament injury. J Hand Surg Am 2012; 37:968-74. [PMID: 22459657 DOI: 10.1016/j.jhsa.2012.01.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/25/2012] [Accepted: 01/25/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the reliability and efficacy of clenched-fist stress radiographs in patients with radioulnar ligament injury. METHODS We examined 30 patients with chronic radioulnar ligament injury. These patients underwent stress radiography, which included clenched-fist posteroanterior (PA) views in forearm pronation and computed tomography in pronation. We measured distal radioulnar joint (DRUJ) gap distance and ulnar variance using clenched-fist PA views. We measured the radioulnar ratio with pronated computed tomography to quantify dorsal translation of the ulnar head. We analyzed these radiographic data and compared them between the injured and contralateral sides. We examined test-retest reliability and interobserver and intraobserver reliability using intraclass correlation coefficients as a measurement of the DRUJ gap distance in clenched-fist PA views. RESULTS The DRUJ gap distance observed with clenched-fist PA views in injured wrists was significantly greater than in the contralateral side. The DRUJ gap distance observed with stress radiography significantly correlated with the magnitude of the radioulnar ratio in forearm pronation. We found a significant test-retest reliability for measuring DRUJ gap distance using clenched-fist PA views, as well as a significant level of intraobserver and interobserver reliability. CONCLUSIONS The DRUJ gap distance observed with clenched-fist PA radiography in forearm pronation was a reliable parameter and may be useful for evaluating DRUJ instability. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Akio Iida
- Department of Orthopedics, Ishinkai-Yao General Hospital, Osaka, Japan
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Iordache SD, Rowan R, Garvin GJ, Osman S, Grewal R, Faber KJ. Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. J Hand Surg Am 2012; 37:98-103. [PMID: 22129657 DOI: 10.1016/j.jhsa.2011.10.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 10/04/2011] [Accepted: 10/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) of the wrist is increasingly used in the diagnosis of ulnar-sided wrist pain; however, its efficacy in this setting still needs clarification. The purposes of this study were to investigate the prevalence of abnormal MRI findings in the triangular fibrocartilage complex (TFCC) in asymptomatic volunteers and to provide the clinician with comparative data when interpreting MRI results. METHODS A total of 103 asymptomatic volunteers underwent imaging of the wrist using a 1.9-T MR scanner and a send-receive birdcage quadrature coil. The images were evaluated by 3 independent interpreters, 2 musculoskeletal radiologists, and 1 orthopedic hand surgeon. We noted details regarding the TFCC morphology and the presence, characteristics, and location of any TFCC abnormality. RESULTS The TFCC was considered abnormal in 39 wrists. The scans were abnormal in 31 subjects younger than 50 years of age, in 5 subjects 50 to 59 years of age, and in all subjects older than 60 years of age (3 subjects). We diagnosed a complete tear of the TFCC in 23 wrists. An increase in age was correlated with an abnormal TFCC (r(pb) = 0.23; P = .016). CONCLUSIONS The prevalence of incidental TFCC findings in MRI scans of asymptomatic subjects is high. The presence of an abnormal TFCC on MRI may be of questionable clinical meaning, because there is a high incidence of TFCC abnormalities in asymptomatic subjects, particularly those over the age of 50. Imaging results must be viewed in the context of the clinical history and physical examination. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Sorin D Iordache
- Department of Surgery, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
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Park MJ, Lee JS. The relationship between stress positions and pain intensity in triangular fibrocartilage lesions. J Hand Surg Eur Vol 2010; 35:735-9. [PMID: 20732927 DOI: 10.1177/1753193410377838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the relationship between stress applied in several positions of the wrist and pain intensity in triangular fibrocartilage lesions in sixty-one patients who were diagnosed as having triangular fibrocartilage lesions and had a wrist arthroscopy. Before arthroscopy, we stressed the wrist with an axial load applied in four different wrist positions, and the evoked pain was graded into four levels. The patients who had a triangular fibrocartilage lesion on arthroscopy were divided into those with a traumatic tear and those with degenerative changes. While hypersupination and extension of wrist position evoked the most severe pain in patients with a traumatic tear, the intensity of pain did not relate to wrist rotation in patients with degenerative changes.
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Affiliation(s)
- M J Park
- Department of Orthopaedic Surgery, Samsung Medical Center, SungkyunKwan University School of Medicine, Seoul, Korea
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Faber KJ, Iordache S, Grewal R. Magnetic resonance imaging for ulnar wrist pain. J Hand Surg Am 2010; 35:303-7. [PMID: 20141901 DOI: 10.1016/j.jhsa.2009.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 02/02/2023]
Affiliation(s)
- Kenneth J Faber
- Department of Surgery, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
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Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39:837-57. [PMID: 20012039 PMCID: PMC2904904 DOI: 10.1007/s00256-009-0842-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 11/14/2009] [Accepted: 11/17/2009] [Indexed: 02/02/2023]
Abstract
Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.
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Affiliation(s)
- Atsuya Watanabe
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Felipe Souza
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter S. Vezeridis
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Hiroshi Yoshioka
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA ,Department of Radiological Sciences, University of California-Irvine, Irvine, CA USA ,Department of Radiological Sciences, UC Irvine Medical Center, 101 City Drive South, Route 140, Orange, CA 92868 USA
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High-resolution magnetic resonance imaging of triangular fibrocartilage complex lesions in acute wrist trauma: image quality at different field strengths. J Comput Assist Tomogr 2009; 33:579-83. [PMID: 19638854 DOI: 10.1097/rct.0b013e31818c093a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purposes of this study were to assess the diagnostic capacity of a new high-resolution imaging protocol for the wrist and triangular fibrocartilage complex (TFCC) lesions at 3.0 T and to compare it with our established 1.5-T protocol. MATERIALS AND METHODS Twenty-one patients with an acute wrist trauma were examined at a 3.0-T imaging system and agreed to undergo an additional examination at 1.5 T. Magnetic resonance imaging was performed with 1.5-T (standard wrist coil) and 3.0-T (purpose-build phased-array coil) imaging system, using coronal T1-weighted turbo-spin-echo, proton density-weighted fat-saturated, and coronal and axial contrast-enhanced T1-weighted gradient-echo fat-saturated sequences, with reduced voxel size from 0.50 x 0.50 x 3.0 mm (1.5 T) to 0.20 x 0.20 x 1.5 mm (3.0 T). For qualitative analysis, 2 observers assessed in consensus delineation, image quality, and artifacts in anatomical landmarks (cartilage, TFCC, and TFCC lesion) and ranked them on a 5-point scale from 1 (nondiagnostic) to 5 (optimal). For quantitative analysis, measurements of the contrast-to-noise ratio were obtained between disk and surrounding tissue. RESULTS All parts of the TFCC and TFCC lesions (n = 14) were seen significantly better at 3.0 T (mean [SD], 4.6 [0.5] vs 2.6 [1.2], P < 0.0001), with higher ranked overall image quality. In 3 cases, TFCC lesions were seen only at 3.0 T. Proton density-weighted fat-saturated sequence had significantly more artifacts at 3.0 T (2.5 [0.6] vs 1.9 [0.5], P < 0.001) in contrast to T1 sequences. Quantitative evaluation showed significantly higher contrast-to-noise ratio for 3.0 T (5.0 [1.1] vs 3.9 [0.9], P < 0.0001). CONCLUSION Depiction of anatomy and pathology of the TFCC benefits significantly from 3.0-T imaging when higher signal-to-noise ratio is invested into improved spatial resolution. Especially small lesions of the disk were detected only or better at 3.0 T.
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Abstract
Acute trauma to the triangular fibrocartilage complex includes tears of the fibrocartilage articular disk substance and meniscal homolog as well as radioulnar ligament avulsions, with or without an associated fracture. Patient evaluation includes clinical examination, imaging studies, and wrist arthroscopy (diagnostic). The Palmer classification is typically used to define injuries to the triangular fibrocartilage complex. The critical distinction is in differentiating injuries that produce instability of the distal radioulnar joint from those that do not. Also important is the recognition of acute injuries in the context of an ongoing degenerative pattern (ie, Palmer class 2 lesions). Nonsurgical management includes temporary splint immobilization of the wrist and forearm, oral nonsteroidal anti-inflammatory medication, corticosteroid joint injection, and physical therapy. Surgical strategies include débridement, acute repair, and subacute repair. Most surgical procedures can be performed arthroscopically. However, open ligament repair may be needed in the setting of distal radioulnar joint instability.
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Cognet JM, Baur P, Gouzou S, Simon P. [Bulge of the scapholunate ligament: an arthro-CT sign of traumatic scapholunate instability]. ACTA ACUST UNITED AC 2008; 94:182-7. [PMID: 18420064 DOI: 10.1016/j.rco.2007.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2007] [Indexed: 11/19/2022]
Abstract
Tears of the scapholunate ligament are usually diagnosed during an arthro-CT or arthro-MRI examination. Typically, the contrast agent passes from one joint to the other. In certain cases, fibrous scar tissue devoid of any mechanical effect may block the passage and lead to an erroneous interpretation of the images. We reviewed retrospectively patients who underwent arthroscopic treatment for scapholunate tears and who had normal arthro-CT images. We searched for specific aspects suggestive of ligament injury. Analysis of the arthro-CT images demonstrated that a bulge of the scapholunate ligament could be noted in patients whose diagnosis of scapholunate ligament injury was established arthroscopically. We propose that appropriate lecture of wrist images can identify scapholunate ligament injury in patients wrongly considered to be free of wrist injury, but who actually have an occult injury to the scapholunate ligament.
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Affiliation(s)
- J-M Cognet
- Unité de chirurgie du membre supérieur, département de chirurgie orthopédique et traumatologique, CHU de Hautepierre, 67098 Strasbourg, France.
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15
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Bell SJ, Hofmeister EP, Moran SL, Shin AY. The diagnostic utility of midcarpal anesthetic injection in the evaluation of chronic wrist pain. Hand (N Y) 2007; 2:39-45; discussion 46-7. [PMID: 18780061 PMCID: PMC2526045 DOI: 10.1007/s11552-006-9014-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip strength were compared to the presence of intracarpal pathology as confirmed by wrist arthroscopy. Forty-five patients with chronic wrist pain underwent a midcarpal injection of lidocaine with or without corticosteroids. Forty of the 45 underwent comcomitant steroid injections; a majority of the 40 patients reported relief of pain for two or more weeks. Improvement of pain and improvement of grip strength were determined. Each of these patients subsequently underwent a radiocarpal and midcarpal arthroscopy, and the pathologic findings of arthroscopy were compared to the improvement of pain and grip strength. These data were compared to a cohort of six volunteers without history of wrist pain or trauma that underwent midcarpal injection of lidocaine. Statistical analysis was performed using Receiver-Operator-Characteristic analysis. The average age of patients with chronic pain was 30.3 years, with an average of 9.8 months of wrist pain. The ultimate diagnoses included 35 patients with carpal instability dissociative, two with nondissociative instability, seven with complex instability of the carpus, three with extensor carpi ulnaris tendonitis and one with deQuervain's tenosynovitis. After lidocaine injection, the normal cohort had a mean loss of 2 kg (-5.3%) (p = 0.02) in grip strength, whereas the experimental cohort had a mean improvement in grip strength of 5.73 kg (34.4%). Improvement of pain after injection did not correlate with pathologic arthroscopic findings (p = 0.92). Improvement in grip strength after midcarpal lidocaine injection of 6 kg or 28% had a 73% sensitivity and a 70% specificity (p = 0.02) of having intracarpal pathology at the time of arthroscopy. Of the chronic wrist pain patients, only four had a normal arthroscopy, and the remainder had at least one area of significant pathology attributing to their pain. We conclude that a midcarpal injection of lidocaine can serve as an effective diagnostic tool in the evaluation of the patient with chronic wrist pain. Improvement of grip of 28% with or without relief of pain is highly correlated with intracarpal pathology.
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Affiliation(s)
- S. Josh Bell
- Department of Orthopedic Surgery, Naval Hospital Rota, Rota, Spain
| | - Eric P. Hofmeister
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA USA
- Clinical Investigation Department (KCA), Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste. 5, San Diego, CA 92134-1005 USA
| | - Steven L. Moran
- Department of Plastic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN USA
| | - Alexander Y. Shin
- Department of Orthopaedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN USA
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16
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Tanaka T, Yoshioka H, Ueno T, Shindo M, Ochiai N. Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury. J Hand Surg Am 2006; 31:1308-14. [PMID: 17027792 DOI: 10.1016/j.jhsa.2006.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 03/07/2006] [Accepted: 05/02/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether high-resolution magnetic resonance imaging (MRI) could detect injuries to the triangular fibrocartilage complex (TFCC). METHODS Eleven patients who showed both a positive sign during the ulnocarpal stress test and tenderness at the distal end of the ulna had a high-resolution MRI using a 47-mm diameter microscopy coil. Six regions of the TFCC were investigated for injury: the radial attachment, disc, ulnar attachment of the triangular fibrocartilage (TFC), ulnotriquetral ligament, palmar radioulnar ligament (PRUL), and dorsal radioulnar ligament (DRUL). Arthroscopy was performed subsequently on each patient. RESULTS For injuries to the radial attachment or the disc of the TFC, a high-resolution MRI showed 100% sensitivity and 100% specificity compared with arthroscopy. In 3 cases in which injury to the ulnar attachment of the TFC was detected with MRI and examination showed a positive piano-key sign and distal radioulnar joint instability, only 1 injury was confirmed with arthrotomy. For MRI diagnosis of an ulnotriquetral ulnolunate attachment injury, the sensitivity was 100% and the specificity was 70%; however, 3 cases had false-positive results. Finally MRI had 100% sensitivity for detecting DRUL and PRUL injuries, although specificities were 75% and 83%, respectively. With MRI there were 2 false-positive DRUL injury diagnoses and 1 false-positive PRUL injury diagnosis. CONCLUSIONS High-resolution MRI using a microscopy surface coil allowed assessment of each TFCC component and showed a higher accuracy for diagnosing injuries to the radial attachment and the disc of the TFC compared with previous studies. High-resolution MRI, however, was not able to diagnose DRUL, PRUL, or ulnolunate ligament injuries accurately. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Toshikazu Tanaka
- Department of Orthopedic Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan.
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17
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Abstract
Management of distal radius fractures is guided by the pattern and location of injury, degree of deformity, and expectations of bony remodeling based on the amount of remaining skeletal growth.Indications for surgical treatment include unstable or irreducible fractures, open fractures, floating elbow injuries, and neurovascular or soft-tissue compromise precluding cast immobilization. Patients and families should be counseled regarding the potential for post-traumatic distal radial growth arrest following physeal fractures. In these cases, epiphysiodeses, ulnar shortening osteotomies, or corrective radial osteotomies may be performed, depending on the pattern of arrest,degree of deformity, and remaining skeletal growth.TFCC tears may be the source of ulnar-sided wrist pain in children and adolescents, though symptoms and physical examination findings maybe subtle. Patients who have persistent pain and functional limitations despite activity modification and therapy are candidates for surgical treatment. Appropriate repair of peripheral TFCC tears with correction of concomitant wrist pathology restores normal wrist anatomy, alleviates pain, and allows for return to functional activities.
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Affiliation(s)
- Donald S Bae
- Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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18
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Ramnath RR. 3T MR Imaging of the Musculoskeletal System (Part II): Clinical Applications. Magn Reson Imaging Clin N Am 2006; 14:41-62. [PMID: 16530634 DOI: 10.1016/j.mric.2006.01.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The gain in SNR that is afforded by 3T MR imaging systems has tremendous clinical applications in the musculoskeletal system. The potential for demonstrating and enhancing the visibility of normal osseous, tendinous, cartilaginous, and ligamentous structures is exciting. Furthermore, harnessing this added signal to increase spatial resolution may improve our diagnostic abilities in various joints dramatically. Radiologists have enjoyed great success in assessing joint disease with current MR imaging field strengths; however, many intrinsic joint structures remain poorly evaluated, which leads to a golden opportunity for 3T MR imaging. The articular cartilage of the knee, the glenoid labrum of the shoulder, the intrinsic ligaments and TFC of the wrist, the collateral ligaments of the elbow, the labrum and articular cartilage of the hip, and the collateral ligaments of the ankle have been evaluated suboptimally on 1 .5T systems using routine nonarthrographic MR images. Because of the enhanced SNR, the higher spatial resolution, and the greater CNR of intrinsic joint structures at higher field strengths, 3T MR imaging has the potential to improve diagnostic abilities in the musculoskeletal system vastly, which translates into better patient care and management. The author's 2 years of clinical experience with musculoskeletal MR imaging on 3T systems has met and exceeded his expectations, and has bolstered the confidence of his orthopedic surgeons in his diagnoses. As coil technology advances and as the use of parallel imaging becomes more available in the extremities, the author expects to see even more dramatic improvements in image quality.
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Nikken JJ, Oei EHG, Ginai AZ, Krestin GP, Verhaar JAN, van Vugt AB, Hunink MGM. Acute Wrist Trauma: Value of a Short Dedicated Extremity MR Imaging Examination in Prediction of Need for Treatment. Radiology 2005; 234:116-24. [PMID: 15618379 DOI: 10.1148/radiol.2341031067] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess predictive value of a short magnetic resonance (MR) imaging examination in addition to or instead of radiography in patients with acute wrist trauma to identify patients who require additional treatment versus those who do not and can be discharged without further follow-up. MATERIALS AND METHODS Informed consent was obtained from all participating patients; the institutional review board approved the randomized controlled trial and use of data to create prediction models. Of 90 patients (37 female, 53 male; mean age, 40.0 years), 87 with acute wrist trauma were randomized to undergo radiography (n = 43) or radiography and a short MR imaging examination with low-field-strength dedicated extremity MR system (n = 44). Age, sex, trauma mechanism, presence of tenderness of the anatomic snuffbox, radiographic results, MR imaging results, and treatment data were collected. Univariable and multivariable logistic regression analysis was used to create four models for prediction of treatment need. RESULTS Thirty-six patients had one or more fractures; one patient had a marked soft-tissue lesion. In univariable analysis, age (odds ratio, 1.02; 95% confidence interval: 1.00, 1.05), anatomic snuffbox tenderness (odds ratio, 2.31; 95% confidence interval: 0.90, 5.96), radiographic results (odds ratio, 31.2; 95% confidence interval: 8.90, 109), and positive MR imaging results versus MR imaging not performed (odds ratio, 1.86; 95% confidence interval: 0.57, 6.06) were significantly predictive of treatment need. In multivariable analysis, radiographic results (odds ratio, 24.7; 95% confidence interval: 6.59, 93.1) and positive MR imaging results (odds ratio, 6.28; 95% confidence interval: 1.27, 31.0) were significantly predictive of treatment need. Negative MR imaging results were not significantly predictive (odds ratio, 0.87; 95% confidence interval: 0.20, 3.82). CONCLUSION A short MR imaging examination with a low-field-strength MR imaging system following radiography in initial evaluation of patients with acute wrist trauma has additional value in prediction of treatment need; it does not have value in identification of patients who can be discharged without further follow-up.
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Affiliation(s)
- Jeroen J Nikken
- Program for the Assessment of Radiological Technology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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20
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Abstract
Magnetic resonance imaging, with its multiplanar imaging capability and superior soft-tissue contrast, has become the preferred method for imaging sports-related injuries. Advances in gradient technology, receiver coils, and imaging software have allowed the imaging of the injured athlete to take place quickly and at high resolution. Understanding the tissues being imaged, the underlying anatomy, and the capabilities of today's scanners is crucial to the design of intelligent and efficient protocols.
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Affiliation(s)
- Garry E Gold
- Department of Radiology, Stanford University, California, USA.
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