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Stensby JD, Fox MG, Nacey N, Blankenbaker DG, Frick MA, Jawetz ST, Raizman NM, Said N, Stephens LA, Subhas N, Walker EA, Wright CL, Chang EY. ACR Appropriateness Criteria® Chronic Hand and Wrist Pain: 2023 Update. J Am Coll Radiol 2024; 21:S65-S78. [PMID: 38823956 DOI: 10.1016/j.jacr.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Chronic hand and wrist pain is a common presenting complaint. The intricate anatomy results in a variety of pain generators-multiple bones, articular cartilage, intrinsic ligaments, triangular fibrocartilage complex, joint capsules and synovium, tendons and tendon sheaths, muscles, and nerves-in a compact space. The need for imaging and the choice of the appropriate imaging modality are best determined by the patient's presentation, physical examination, and the clinician's working differential diagnosis. Radiography is usually appropriate as the initial imaging study in the evaluation of chronic hand or wrist pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Nicholas Nacey
- Panel ViceChair, University of Virginia Health System, Charlottesville, Virginia
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; American Academy of Orthopaedic Surgeons
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Luke A Stephens
- University of Missouri School of Medicine, Columbia, Missouri, Primary care physician
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Chadwick L Wright
- The Ohio State University Wexner Medical Center, Columbus, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Malshikare VA, Jerome JTJ. Computed Tomographic Arthrography (Arthroscanner) of the Wrist Joint: Why, How, and When. Indian J Orthop 2023; 57:930-937. [PMID: 37214381 PMCID: PMC10192499 DOI: 10.1007/s43465-023-00860-3] [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: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 05/24/2023]
Abstract
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.
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Morway GR, Miller A. Clinical and Radiographic Evaluation of Ulnar-Sided Wrist Pain. Curr Rev Musculoskelet Med 2022; 15:590-596. [PMID: 36173549 PMCID: PMC9789218 DOI: 10.1007/s12178-022-09790-3] [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] [Accepted: 08/31/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Ulnar-sided wrist pain is a challenging diagnostic workup. A thorough and complete physical examination followed by appropriate radiographic studies can help the clinician diagnose and treat these conditions. RECENT FINDINGS Recent research has been focused on diagnostic modalities such as arthroscopy and high-resolution MRI. Ulnar-sided wrist pain is a challenging clinical workup that must be approached systematically with the aid of adjunctive diagnostic modalities.
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Affiliation(s)
| | - Andrew Miller
- Philadelphia Hand to Shoulder Center at Thomas Jefferson University Hospital, 834 Chestnut St G114, Philadelphia, PA USA
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Radio-carpal wrist MR arthrography: comparison of ultrasound with fluoroscopy and palpation-guided injections. Skeletal Radiol 2022; 51:765-775. [PMID: 34324016 DOI: 10.1007/s00256-021-03845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare ultrasound- (US), fluoroscopy- (FL), and palpation-guided contrast injection techniques used for dorsal radio-carpal wrist MRA. MATERIALS AND METHODS Patients with chronic wrist pain were randomized as to which injection technique they underwent into three groups of 50 participants. Dorsal radio-carpal contrast injection was performed under US, FL guidance (one radiologist for each), or palpation guidance by an orthopedic surgeon. The three techniques were compared by procedure time, success rate, number of attempts needed, frequency and grade of extravasation, joint distension, and MRA image quality. Additionally, any change from baseline wrist pain was recorded using the visual analog scale (VAS) at five time points (immediately, 8 h, 24 h, 48 h, and 1 week) after injection. RESULTS One hundred and fifty patients (83 males and 67 females; mean age 29 ± 6.5 years) were included. Success rates for US- and FL-guided injections were 100%, while palpation-guided approach was significantly less successful (72%) (P = 0.02) with significantly more frequent extravasation (56%)(P < 0.001). US guidance was the least time-consuming (6.5 ± 1.6 min) compared to FL guidance (12.5 ± 1.9 min) and palpation guidance (8 ± 1.2 min) (all P < 0.001). The mean number of joint puncture attempts was significantly lower with imaging-guided techniques (1.1 ± 0.24 and 1.2 ± 0.4 for US and FL, P = 0.23) compared to palpation-guided one (1.6 ± 0.8) (P = 0.007). The largest increases in baseline-pain were 8-h post-injection, and US guidance was the least painful at all-time points (all P < 0.05). Joint distension and image quality were significantly better with imaging-guided techniques (P < 0.001 and P = 0.003). CONCLUSIONS US-guided radio-carpal injection is a less time-consuming, more tolerable, and successful radiation-free method when compared to FL guidance. Palpation-guided injections require multiple attempts to enter the joint with high failure rates and frequent extravasation.
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Van Overstraeten L, Camus EJ, Moungondo F, Schuind F. Volar Ganglion Cyst and Echo-Guided Assistance for the Arthroscopic Removal. Hand Clin 2022; 38:101-107. [PMID: 34802602 DOI: 10.1016/j.hcl.2021.08.011] [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] [Indexed: 02/02/2023]
Abstract
The ganglion of the wrist is very common but with uncertain prognosis. The arthroscopic resection seems to improve the result compared with open procedure, in decreasing recurrence and morbidity. Volar ganglions are close to the radial artery, the flexor pollicis longus tendon, and even the median nerve. Ultrasonography combined with arthroscopy offers incomparable safety for the resection of volar ganglions. The technical steps of this combined procedure are described, and the first published series are discussed.
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Affiliation(s)
- Luc Van Overstraeten
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium; Hand and Wrist Center, HFSU, AO Foundation, Tournai, Belgium.
| | - Emmanuel Jacques Camus
- Department of Orthopaedic and Traumatologic Surgery, University Clinical Center, Polyclinic Val de Sambre, Maubeuge, France
| | - Fabian Moungondo
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium
| | - Frédéric Schuind
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium
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Kreulen RT, Nayar SK, Alfaki Y, LaPorte D, Demehri S. Advanced Imaging of Ulnar Wrist Pain. Hand Clin 2021; 37:477-486. [PMID: 34602127 DOI: 10.1016/j.hcl.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain can be a diagnostic challenge for clinicians and radiologists. The ulnar wrist has complex morphology and is composed of many small bone and soft tissue structures. Within these structures, a wide variety of pathologic conditions can occur. To successfully diagnose and treat these pathologic conditions, clinicians and radiologists must have a strong understanding of the advanced imaging techniques available to them. In this review, the authors present a brief review of the normal ulnar wrist anatomy, discuss the differential diagnosis of ulnar-sided wrist pain, and examine the indications for different advanced imaging modalities.
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Affiliation(s)
- R Timothy Kreulen
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA.
| | - Suresh K Nayar
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Yasmin Alfaki
- Johns Hopkins University, 3400 North Charles Street, Mason Hall, Baltimore, MD 21218, USA
| | - Dawn LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Shadpour Demehri
- Johns Hopkins Department of Musculoskeletal Radiology, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
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Abstract
Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called "scapholunate complex" has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).
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Labèr R, Reissner L, Nagy L, Schweizer A. Feasibility of ultrasound-based measurement of dorsal scaphoid displacement: A 3D-model study. HAND SURGERY & REHABILITATION 2021; 40:595-601. [PMID: 34058396 DOI: 10.1016/j.hansur.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
The present study aimed to develop a reliable dynamic measurement technique, which can be used directly in the outpatient setting, based on dorsal subluxation of the scaphoid on scaphoid shift test. This study was designed to evaluate feasibility and to quantify dorsal subluxation of the scaphoid in relation to the lunate. Based on a scaphoid shift test under ultrasonography, a standardized 3D test model was developed to measure subluxation. Sagittal subluxation ranged between 0 and 6 mm, as checked on the implemented scale. Four hand surgeons trained in ultrasonography (experience level II-V) performed blinded measurements (total of 52, n = 13 per investigator) with a standardized measurement protocol. Dorsal subluxation of the scaphoid was measured in relation to the lunate. Interobserver reliability on intraclass correlation coefficient (ICC) was excellent, at 0.97 (95% confidence interval, 0.930-0.992). Mean overall absolute measurement error was 0.27 mm ± 0.21. Dorsal subluxation of the scaphoid can thus be accurately measured on ultrasound with excellent interobserver reliability, quantifying and improving clinical assessment of scapholunate instability.
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Affiliation(s)
- R Labèr
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - L Reissner
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - L Nagy
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - A Schweizer
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
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Huflage H, Luetkens KS, Kunz AS, Conrads N, Jakubietz RG, Jakubietz MG, Pennig L, Goertz L, Bley TA, Schmitt R, Grunz JP. Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography. Eur Radiol 2021; 31:9399-9407. [PMID: 34003353 PMCID: PMC8589820 DOI: 10.1007/s00330-021-08024-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 01/06/2023]
Abstract
Objectives Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist. Methods Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated. Results Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers’ confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting. Conclusions Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions. Key Points • In multi-compartment arthrography of the wrist, ancillary radial plane view aids assessability of the foveal and styloid ulnar-sided insertions of the triangular fibrocartilage complex. • Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions. • Additional radial planes provide greater diagnostic confidence.
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Affiliation(s)
- Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rafael Gregor Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Michael Georg Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Radiology, University Hospital LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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Dornberger JE, Rademacher G, Stengel D, Hönning A, Dipl-Phys GS, Eisenschenk A, Mutze S, Goelz L. What Is the Diagnostic Accuracy of Flat-panel Cone-beam CT Arthrography for Diagnosis of Scapholunate Ligament Tears? Clin Orthop Relat Res 2021; 479:151-160. [PMID: 32701771 PMCID: PMC7899599 DOI: 10.1097/corr.0000000000001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cone beam CT (CBCT) is a widely available technique with possible indications in carpal ligament injuries. The accuracy of CBCT arthrography in diagnosing traumatic tears of the scapholunate ligament has not been reported. QUESTIONS/PURPOSES (1) What is the diagnostic accuracy of CBCT and how does it relate to the accuracy of multislice CT arthrography and conventional arthrography in diagnosing scapholunate ligament tears? (2) What is the estimated magnitude of skin radiation doses of each method? METHODS This secondary analysis of a previous prospective study included 71 men and women with suspected scapholunate ligament tears and indications for arthroscopy. Preoperative imaging was conventional arthrography and either MSCT arthrography for the first half of patients to be included (n = 36) or flat-panel CBCT arthrography for the remaining patients (n = 35). Index tests identified therapy-relevant SLL tears with dorsal or complete SLL ruptures, and these tears were compared with relevant SLL tears which were determined through arthroscopy as Geissler Stadium III and IV by probing the instable SL joint with a microhook or arthroscope. These injuries were treated by open ligament repair and Kirschner wire fixation. Accuracy values and 95% confidence intervals were calculated. Additional estimates of the radiation skin doses of each CBCT exam and two MSCT protocols were subsequently calculated using dose area products, dose length products, and CT dose indices. RESULTS The diagnostic accuracy was high for all imaging methods. 95% CIs were broadly overlapping and therefore did not indicate differences between the diagnostic groups: Sensitivity of CBCT arthrography was 100% (95% CI 77 to 100), specificity was 95% (95% CI 76 to 99.9), positive predictive value was 93% (95% CI 68 to 99.8), and negative predictive value was 100% (95% CI 83 to 100). For MSCT arthrography, the sensitivity was 92% (95% CI 64 to 99.8), specificity was 96% (95% CI 78 to 99.9), positive predictive value was 92% (95% CI 64 to 99.8), and negative predictive value was 96% (95% CI 78 to 99.9). For conventional arthrography, the sensitivity was comparably high: 96% (95% CI 81 to 99.9). Specificity was (81% [95% CI 67 to 92]); the positive predictive value was 77% (95% CI 59 to 89) and negative predictive value was 97% (95% CI 86 to 99.9). Estimated mean (range) radiation skin doses were reported in a descriptive fashion and were 12.9 mSv (4.5 to 24.9) for conventional arthrography, and 3.2 mSv (2.0 to 4.8) for CBCT arthrography. Estimated radiation skin doses were 0.2 mSv and 12 mSv for MSCT arthrography, depending on the protocol. CONCLUSION Flat-panel CBCT arthrography can be recommended as an accurate technique to diagnose scapholunate ligament injuries after wrist trauma. Estimated skin doses are low for CBCT arthrography and adapted MSCT arthrography protocols. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Jenny E Dornberger
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Grit Rademacher
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Dirk Stengel
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Hönning
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Gabriele Schüler Dipl-Phys
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Eisenschenk
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Sven Mutze
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Leonie Goelz
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
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11
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Brui E, Efimtcev AY, Fokin VA, Fernandez R, Levchuk AG, Ogier AC, Samsonov AA, Mattei JP, Melchakova IV, Bendahan D, Andreychenko A. Deep learning-based fully automatic segmentation of wrist cartilage in MR images. NMR IN BIOMEDICINE 2020; 33:e4320. [PMID: 32394453 PMCID: PMC7784718 DOI: 10.1002/nbm.4320] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 05/10/2023]
Abstract
The study objective was to investigate the performance of a dedicated convolutional neural network (CNN) optimized for wrist cartilage segmentation from 2D MR images. CNN utilized a planar architecture and patch-based (PB) training approach that ensured optimal performance in the presence of a limited amount of training data. The CNN was trained and validated in 20 multi-slice MRI datasets acquired with two different coils in 11 subjects (healthy volunteers and patients). The validation included a comparison with the alternative state-of-the-art CNN methods for the segmentation of joints from MR images and the ground-truth manual segmentation. When trained on the limited training data, the CNN outperformed significantly image-based and PB-U-Net networks. Our PB-CNN also demonstrated a good agreement with manual segmentation (Sørensen-Dice similarity coefficient [DSC] = 0.81) in the representative (central coronal) slices with a large amount of cartilage tissue. Reduced performance of the network for slices with a very limited amount of cartilage tissue suggests the need for fully 3D convolutional networks to provide uniform performance across the joint. The study also assessed inter- and intra-observer variability of the manual wrist cartilage segmentation (DSC = 0.78-0.88 and 0.9, respectively). The proposed deep learning-based segmentation of the wrist cartilage from MRI could facilitate research of novel imaging markers of wrist osteoarthritis to characterize its progression and response to therapy.
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Affiliation(s)
- Ekaterina Brui
- University of Information Technology Mechanics and Optics, International Research Center Nanophotonics and Metamaterials, 199034 S.-Petersburg, Russia
| | - Aleksandr Y. Efimtcev
- University of Information Technology Mechanics and Optics, International Research Center Nanophotonics and Metamaterials, 199034 S.-Petersburg, Russia
- Federal Almazov North-West Medical Research Center, 197341 S.-Petersburg, Russia
| | - Vladimir A. Fokin
- University of Information Technology Mechanics and Optics, International Research Center Nanophotonics and Metamaterials, 199034 S.-Petersburg, Russia
- Federal Almazov North-West Medical Research Center, 197341 S.-Petersburg, Russia
| | - Remi Fernandez
- APHM, Service de Radiologie, Hôpital de la Conception, Marseille, France
| | - Anatoliy G. Levchuk
- Federal Almazov North-West Medical Research Center, 197341 S.-Petersburg, Russia
| | - Augustin C. Ogier
- Aix-Marseille Universite, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
| | - Alexey A. Samsonov
- University of Wisconsin-Madison, Department of Radiology, Madison, WI 53705-2275 USA
| | - Jean. P. Mattei
- Aix-Marseille Universite, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
- Assistance Publique Hôpitaux de Marseille, Institut de l’appareil locomoteur, Service de Rhumatologie, Hôpital Sainte Marguerite, Marseille, France
| | - Irina V. Melchakova
- University of Information Technology Mechanics and Optics, International Research Center Nanophotonics and Metamaterials, 199034 S.-Petersburg, Russia
| | - David Bendahan
- Aix-Marseille Universite, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
| | - Anna Andreychenko
- University of Information Technology Mechanics and Optics, International Research Center Nanophotonics and Metamaterials, 199034 S.-Petersburg, Russia
- Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Moscow, Russia
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12
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Quere JB, Phan C, Miquel A, Li L, Arrivé L, Menu Y, Crema MD. MDCT arthrography assessment of the severity of cartilage damage and scapholunate dissociation in regard to specific-component tears of the scapholunate interosseous ligament. Eur J Radiol 2020; 125:108901. [DOI: 10.1016/j.ejrad.2020.108901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
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13
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Moser TP, Martinez AP, Andoulsi S, Jeantroux J, Cardinal É. Radiographic/MR Imaging Correlation of the Wrist. Magn Reson Imaging Clin N Am 2019; 27:601-623. [PMID: 31575396 DOI: 10.1016/j.mric.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this review article, the authors discuss the imaging features of the most common pathologic conditions of the wrist by putting the emphasis on radiographic and MR imaging correlations. A topographic approach based on the 3 functional columns of the wrist (radial, central, and ulnar) serves as a framework. The pathologic conditions are classified, based on the structures involved, as fractures, ligament injuries, arthropathies, bone abnormalities, and tendinopathies. The authors describe and evaluate classic radiographic signs and explain how they correlate with MR imaging. The advantages and limitations of each technique are thoroughly discussed as well as other imaging modalities.
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Affiliation(s)
- Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada.
| | - Adriana P Martinez
- Department of Orthopedic Surgery, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Sooheib Andoulsi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada
| | - Jérémy Jeantroux
- Service d'Imagerie Médicale, Clinique St-François, 1-5, rue Colomé, Haguenau 67502, France
| | - Étienne Cardinal
- Medvue, 5811 Côte-des-Neiges Road, Montreal, Québec H3S 1Z2, Canada
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14
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Torabi M, Lenchik L, Beaman FD, Wessell DE, Bussell JK, Cassidy RC, Czuczman GJ, Demertzis JL, Khurana B, Klitzke A, Motamedi K, Pierce JL, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Acute Hand and Wrist Trauma. J Am Coll Radiol 2019; 16:S7-S17. [DOI: 10.1016/j.jacr.2019.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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15
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Malshikare VA. Perthes-Like Lesion in Wrist Joint: Stripping of Ulnar Collateral Ligament. J Wrist Surg 2019; 8:152-156. [PMID: 30941257 PMCID: PMC6443398 DOI: 10.1055/s-0038-1672152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Background Chronic ulnar-sided wrist pain often proves to be a challenging presenting complaint. A new type of injury to the ulnar collateral ligament (UCL) of the wrist is described in a young female. It is characterized by stripping of UCL from ulnar attachment. Case Description A 32-year-old female sustained an injury after lifting heavy weight. Examination revealed tenderness to the ulnar styloid, terminal radial deviation was painful and decreased grip strength. The arthro-computed tomography (Arthroscanner) diagnosed stripping of ulnar collateral ligament (UCL). The UCL was refixed with transosseous sutures. At one year follow-up, the patient was pain-free with good range of motion and improved grip strength. Literature Review After intense literature review, we found this type of injury was not reported, but we found the same type of injury in the shoulder "Perthes lesion." Clinical Relevance The UCL stripping of the wrist is a rare entity and undiagnosed on routine investigation. This lesion was only diagnosed on an arthroscanner and was missed on MR study which is commonly used for diagnosed wrist pain. This case is being reported for its rarity and to expand the differential diagnosis of the ulnar-sided wrist pain.
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Affiliation(s)
- Vijay A. Malshikare
- Department of Hand and Wrist Surgery, Jehangir Hospital, Pune, Maharashtra, India
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16
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Strobel K, van der Bruggen W, Hug U, Gnanasegaran G, Kampen WU, Kuwert T, Paycha F, van den Wyngaert T. SPECT/CT in Postoperative Hand and Wrist Pain. Semin Nucl Med 2018; 48:396-409. [DOI: 10.1053/j.semnuclmed.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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MDCT arthrography assessment of scaphoid nonunion advanced collapse: distribution of cartilage damage and relationship with scaphoid nonunion features. Skeletal Radiol 2018. [PMID: 29520536 DOI: 10.1007/s00256-018-2907-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Our primary aim was to evaluate the distribution and severity of cartilage damage in a sample of patients with scaphoid nonunion advanced collapse (SNAC), assessed on MDCT arthrography, with regard to two well-known SNAC staging systems. Secondarily, we wanted to see if the degree of cartilage damage varied with the location of the nonunion. METHODS We retrospectively included 35 patients with a history of SNAC who had undergone MDCT arthrography. The location of the fracture was defined as the proximal, middle, or distal third of the scaphoid. Cartilage damage was assessed in 14 distinct regions of the wrist using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. Staging of SNAC for each patient was based on the distribution of cartilage damage seen on MDCT arthrography. The one-way ANOVA test was used to evaluate whether global cartilage damage scores differed between patients with proximal vs middle and distal nonunion. RESULTS The radial styloid-scaphoid (85.7%), the scaphoid-trapezium-trapezoid (60%), the scapho-capitate (57.1%), and the proximal radio-scaphoid joints (42.9%) were most commonly affected by degenerative cartilage damage. A substantial number of patients could not be classified according to the two SNAC staging systems. Patients with proximal nonunion exhibited a higher mean score of global cartilage damage than patients with middle or distal nonunion: 14.3 ± 9.5 (95% CI 9.8, 18.7) vs 8.6 ± 6.9 (95% CI 4.7, 12.4); p < 0.0001. CONCLUSION The distribution of cartilage damage does not always follow the pattern of progressive osteoarthritis widely described in SNAC. Proximal scaphoid nonunion is related to greater severity of global cartilage damage.
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18
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Maloney E, Zbojniewicz AM, Nguyen J, Luo Y, Thapa MM. Anatomy and injuries of the pediatric wrist: beyond the basics. Pediatr Radiol 2018; 48:764-782. [PMID: 29557490 DOI: 10.1007/s00247-018-4111-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/12/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
Ligamentous injuries of the pediatric wrist, once thought to be relatively uncommon, are increasingly recognized in the context of acute high-energy mechanism trauma and chronic axial loading, including those encountered in both recreational and high-performance competitive sports. Recent advances in MR-based techniques for imaging the pediatric wrist allow for sensitive identification of these often radiographically occult injuries. Detailed knowledge of the intrinsic and supportive extrinsic ligamentous complexes, as well as normal developmental anatomy and congenital variation, are essential to accurately diagnose injuries to these structures. Early identification of ligamentous injury of the pediatric wrist is essential within the conservative treatment culture of modern pediatric orthopedics because treatment of these lesions often necessitates surgery, and outcomes often depend on early and sometimes aggressive intervention. In this article, we review MR arthrogram technique and pediatric wrist anatomy, and correlate appearances on MR and selected ligamentous pathologies of the pediatric wrist.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Andrew M Zbojniewicz
- Division of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, College of Human Medicine, Helen DeVos Children's Hospital, Advanced Radiology Services, Michigan State University, Grand Rapids, MI, USA
| | - Jie Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yu Luo
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, TN, USA
| | - Mahesh M Thapa
- Department of Radiology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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19
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Allam MFAB, Elian MMM, Allam AFAB. The value of multi-detector CT arthrography of the wrist joint in evaluation of ligamentous and capsular injuries in post-traumatic pain. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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ACR Appropriateness Criteria ® Chronic Wrist Pain. J Am Coll Radiol 2018; 15:S39-S55. [DOI: 10.1016/j.jacr.2018.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/12/2023]
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21
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Bhure U, Roos JE, Pérez Lago MDS, Steurer I, Grünig H, Hug U, Strobel K. SPECT/CT arthrography. Br J Radiol 2017; 91:20170635. [PMID: 29099611 DOI: 10.1259/bjr.20170635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Single photon emission CT (SPECT)/CT arthrography, the combination of CT arthrography and late phase bone SPECT/CT, has been developed in 2011 and so far used in knee, ankle and wrist joints. SPECT/CT offers functional information about increased bone turnover in combination with morphological details. Compared with SPECT/CT alone, additional intra-articular contrast enables the assessment of cartilage, menisci, ligaments and loose bodies. SPECT/CT arthrography is a promising alternative technique for the evaluation of internal derangement of joints in patients with MR contraindications and/or metallic implants. In this article, we review and report our 5-year experience with this technique illustrated with patient examples and give a perspective for future applications.
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Affiliation(s)
- Ujwal Bhure
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Justus E Roos
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Isabelle Steurer
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Hannes Grünig
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Urs Hug
- 2 Department of Hand and Plastic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Klaus Strobel
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
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22
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Shahabpour M, Staelens B, Van Overstraeten L, De Maeseneer M, Boulet C, De Mey J, Scheerlinck T. Advanced imaging of the scapholunate ligamentous complex. Skeletal Radiol 2015. [PMID: 26219592 DOI: 10.1007/s00256-015-2182-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.
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Affiliation(s)
- Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Barbara Staelens
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | | | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Cedric Boulet
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Thierry Scheerlinck
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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23
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Lungu E, Moser TP. A practical guide for performing arthrography under fluoroscopic or ultrasound guidance. Insights Imaging 2015; 6:601-10. [PMID: 26493836 PMCID: PMC4656236 DOI: 10.1007/s13244-015-0442-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/24/2015] [Accepted: 10/07/2015] [Indexed: 11/25/2022] Open
Abstract
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
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Affiliation(s)
- Eugen Lungu
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, 1560 rue Sherbrooke Est, Montréal, QC, H2L 4M1, Canada
| | - Thomas P Moser
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada. .,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, 1560 rue Sherbrooke Est, Montréal, QC, H2L 4M1, Canada.
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24
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Klempka A, Wagner M, Fodor S, Prommersberger KJ, Uder M, Schmitt R. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography. Eur Radiol 2015; 26:722-32. [DOI: 10.1007/s00330-015-3871-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/24/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
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25
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Abstract
With advances in imaging technology, there has been a significant increase in the number and range of interventional musculoskeletal image-guided procedures. One of the most commonly performed image-guided musculoskeletal interventions is the diagnostic and therapeutic percutaneous aspiration and drainage of multiple types of intra-articular, juxta-articular, and intramuscular pathologic fluid collections. These procedures may be performed under fluoroscopic, ultrasound, computed tomography, or even magnetic resonance guidance depending on the location to be accessed, type of pathology, patient characteristics, and operator preference. Musculoskeletal image-guided aspiration and drainage procedures are minimally invasive and generally very safe while offering valuable diagnostic information as well as therapeutic benefit. This article focuses on the appropriate indications, contraindications, and general technique for accessing the major joints via imaging guidance. For each joint, we discuss pertinent anatomy, appropriate imaging modalities, and preferred approaches to gaining intra-articular access. Additionally, the article discusses some of the more frequently encountered juxta-articular and intramuscular fluid collections that can be accessed and aspirated via percutaneous intervention, with mention of the importance of recognizing extremity sarcomas that can mimic these benign collections.
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Affiliation(s)
- Barry Glenn Hansford
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
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26
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The role of MDCT arthrography in the follow-up of scapholunate stabilisation. Radiol Med 2013; 118:1157-70. [PMID: 23801397 DOI: 10.1007/s11547-013-0949-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/04/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to assess outcomes in a group of patients with scapholunate dissociation treated with stabilisation surgery (Brunelli-Stanley) and to compare arthrography with multidetector computed tomography (MDCT) with conventional radiography, the gold standard in the follow-up of wrist surgery. MATERIALS AND METHODS Twelve patients (13 wrists) underwent surgery for scapholunate dissociation and were followed up with clinical (visual analogue scale, Mayo Wrist Score, Patient-Rated Wrist Evaluation, and Disabilities of the Arm, Shoulder, and Hand) and radiological assessment (conventional radiography and CT arthrography). Conventional radiography was assessed for: the scapholunate gap, scapholunate angle, radiolunate angle, capitate-lunate angle, and carpal height index; the CT arthrography images were also evaluated for: the distance between the dorsal exit hole of the bone tunnel and the proximal scaphoid pole, the thickness and tension of the flexor carpi radialis (FCR) strip, and any signs of joint degeneration. RESULTS Analysis of the data from conventional radiography and MDCT arthrography demonstrated a significant statistical correlation among the measurements obtained on the radiograms and multiplanar CT reconstructions and the patients' clinical outcome. CONCLUSIONS Our results show that MDCT arthrography has the same value as conventional radiography in the evaluation of standard parameters (scapholunate gap, scapholunate angle, radiolunate angle, capitolunate angle, carpal height index), but in addition provides an accurate delineation of the FCR tendon graft, allowing differentiation of its thickness, direction and degree of tension.
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27
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C-arm flat-panel CT arthrography of the wrist and elbow: first experiences in human cadavers. Skeletal Radiol 2013; 42:419-29. [PMID: 22926680 DOI: 10.1007/s00256-012-1501-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/02/2012] [Accepted: 08/05/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the optimal intra-articular iodine concentration for C-arm flat-panel computed tomography (FPCT) arthrography using advanced joint phantoms and to evaluate its application in human cadaveric wrists and elbows. Multi-detector (MD) CT served as the standard of reference. MATERIALS AND METHODS Joint phantoms and 10 human cadaveric wrist and elbow joints were scanned with C-arm FPCT (5-s, 8-s, and 20-s runs) and standard MDCT using different and optimal concentrations of iodinated contrast material. CT numbers of contrast material, tissue, and noise were measured and contrast-to-noise ratios (CNR) calculated for quantitative analysis. Image and depiction of cartilage, bone, and soft tissues were rated. Radiation doses were compared. RESULTS In FPCT, iodine concentrations positively correlated with CT numbers and noise of contrast material and with radiation dose (r = 0.713-0.996, p < 0.05 each). At an iodine concentration of 45 mg/ml, CNR of cartilage and soft tissues were highest for all FPCT acquisitions and higher than in MDCT. The 20-s FPCT run performed best for image quality and depiction of anatomical structures and was rated overall equal to MDCT (p = 0.857). CONCLUSION The optimal iodine concentration for C-arm FPCT arthrography in this study is 45 mg/ml, leading to superior CNR and image quality for an optimal FPCT protocol compared with standard MDCT arthrography in human cadaveric joints.
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Syed MA, Raj V, Jeyapalan K. Current Role of Multidetector Computed Tomography in Imaging of Wrist Injuries. Curr Probl Diagn Radiol 2013; 42:13-25. [PMID: 23146166 DOI: 10.1067/j.cpradiol.2012.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mohd Arif Syed
- Department of Radiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
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Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse: MDCT Arthrography Features. AJR Am J Roentgenol 2012; 199:W202-7. [DOI: 10.2214/ajr.11.7574] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Smith TO, Drew B, Toms AP, Jerosch-Herold C, Chojnowski AJ. Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis. J Bone Joint Surg Am 2012; 94:824-32. [PMID: 22552672 DOI: 10.2106/jbjs.j.01775] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulnar-sided wrist pain and resultant functional disability. Diagnosis is based on the history and clinical examination as well as radiographic evidence of a TFCC central perforation or a radial/ulnar tear. The purpose of this study was therefore to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the detection of TFCC injury in the adult population. METHODS Published and unpublished literature databases were searched. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary receiver operating characteristic curve evaluations were performed. The methodological quality of each study was assessed with use of the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. RESULTS Twenty-one studies were included in the review, and these series included a total of 982 wrists. On meta-analysis, MRA was superior to MRI in the investigation of full-thickness TFCC tears, with a pooled sensitivity of 0.75 and a pooled specificity of 0.81 for MRI compared with 0.84 and 0.95, respectively, for MRA. MRA and MRI performed at greater field strengths were reported to have greater sensitivity and specificity than those performed at lower field strengths. There were insufficient data to assess the diagnostic test accuracy for partial-thickness TFCC tears. CONCLUSIONS Given its acceptable diagnostic test accuracy, it is recommended that MRA, rather than MRI, be performed in when there are questions about the diagnosis and subsequent management of patients with ulnar-sided wrist pain.
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Affiliation(s)
- Toby O Smith
- Faculty of Health, University of East Anglia, Norwich, United Kingdom.
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Toms AP, Chojnowski A, Cahir JG. Midcarpal instability: a radiological perspective. Skeletal Radiol 2011; 40:533-41. [PMID: 20467868 DOI: 10.1007/s00256-010-0941-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/12/2010] [Accepted: 04/12/2010] [Indexed: 02/02/2023]
Abstract
Midcarpal instability (MCI) is the result of complex abnormal carpal motion at the midcarpal joint of the wrist. It is a form of non-dissociative carpal instability (CIND) and can be caused by various combinations of extrinsic ligament injuries that then result in one of several subtypes of MCI. The complex patterns of injury and the kinematics are further complicated by competing theories, terminology and classifications of MCI. Palmar, dorsal, ulna midcarpal instability, and capitolunate or chronic capitolunate instability are all descriptions of types of MCI with often overlapping features. Palmar midcarpal instability (PMCI) is the most commonly reported type of MCI. It has been described as resulting from deficiencies in the ulna limb of the palmar arcuate ligament (triquetrohamate-capitate) or the dorsal radiotriquetral ligaments, or both. Unstable carpal articulations can be treated with limited carpal arthrodesis or the ligamentous defects can be treated with capsulorrhaphy or ligament reconstruction. Conventional radiographic abnormalities are usually limited to volar intercalated segment instability (VISI) patterns of carpal alignment and are not specific. For many years stress view radiographs and videofluoroscopy have been the methods of choice for demonstrating carpal instability and abnormal carpal kinematics respectively. Dynamic US can be also used to demonstrate midcarpal dyskinesia including the characteristic triquetral "catch-up" clunk. Tears of the extrinsic ligaments can be demonstrated with MR arthrography, and probably with CT arthrography, but intact yet redundant ligaments are more difficult to identify. The exact role of these investigations in the diagnosis, categorisation and management of midcarpal instability has yet to be determined.
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Affiliation(s)
- Andoni Paul Toms
- Department of Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK.
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Vekens EVD, Bergman EHJ, Vanderperren K, Raes EV, Puchalski SM, Bree HJJV, Saunders JH. Computed tomographic anatomy of the equine stifle joint. Am J Vet Res 2011; 72:512-21. [DOI: 10.2460/ajvr.72.4.512] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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SPECT/CT arthrography of the wrist in ulnocarpal impaction syndrome. Eur J Nucl Med Mol Imaging 2011; 38:792. [PMID: 21225423 DOI: 10.1007/s00259-010-1712-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/16/2010] [Indexed: 01/01/2023]
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Taljanovic MS, Goldberg MR, Sheppard JE, Rogers LF. US of the Intrinsic and Extrinsic Wrist Ligaments and Triangular Fibrocartilage Complex—Normal Anatomy and Imaging Technique. Radiographics 2011; 31:e44. [DOI: 10.1148/rg.e44] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Comparaison de l’irradiation en scanner et tomosynthèse du poignet. ACTA ACUST UNITED AC 2011; 92:32-9. [DOI: 10.1016/j.jradio.2010.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/01/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
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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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Partial versus partial-thickness tears of the scapholunate and lunatotriquetral ligaments. AJR Am J Roentgenol 2009; 193:W469. [PMID: 19843730 DOI: 10.2214/ajr.09.2898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Work-Up of the Arthritic Wrist. Tech Orthop 2009. [DOI: 10.1097/bto.0b013e3181a07f19] [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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