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Gitto S, Albano D, Serpi F, Spadafora P, Colombo R, Messina C, Aliprandi A, Sconfienza LM. Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:54-60. [PMID: 37001562 DOI: 10.1055/a-2066-9230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the role of ultrasound (US) in the evaluation of intrinsic and extrinsic ligaments of the wrist with magnetic resonance arthrography (MRA) as the reference standard. MATERIALS AND METHODS This prospective study included patients referred for MRA after wrist trauma. US examination was performed just before MRA. On the dorsal and palmar sides of the wrist, the intrinsic interosseus and midcarpal, extrinsic, and collateral ligaments were evaluated. MRA was performed on a 1.5-T unit. In the first 20 patients included, ligament thickness was independently assessed using US and MRA and thickness reproducibility was calculated. Ligament integrity was evaluated in all patients. RESULTS 38 patients (22 men, 16 women; mean age: 38 years) were included. Ligament thickness reproducibility ranged between 44% for the palmar ulnocapitate ligament and 71% for the palmar scaphotriquetral ligament. US had a sensitivity, specificity, positive and negative predictive values, and accuracy of 100% in the identification of tears of the palmar (n=8) and dorsal (n=3) bands of the scapholunate ligament and the ulnar collateral ligament (n=3). It had a sensitivity of 100%, specificity of 97%, positive predictive value of 50%, negative predictive value of 100%, and accuracy of 97% in the identification of tears of the palmar ulnolunate ligament (n=1). CONCLUSION Compared to MRA, US showed good reproducibility in the assessment of wrist ligament thickness and similar accuracy with respect to identifying tears of the scapholunate, palmar ulnolunate, and ulnar collateral ligaments.
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Affiliation(s)
- Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Domenico Albano
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Pierino Spadafora
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Roberta Colombo
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | | | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Okoro CK, Skalski MR, Patel DB, White EA, Matcuk GR. Imaging Diagnosis and Management of Carpal Trauma and Instability-An Illustrated Guide. Life (Basel) 2023; 13:1426. [PMID: 37511801 PMCID: PMC10381215 DOI: 10.3390/life13071426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed.
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Affiliation(s)
- Chukwuemeka K Okoro
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic-West Campus, San Jose, CA 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - George R Matcuk
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal Radioulnar Joint: Normal Anatomy, Imaging of Common Disorders, and Injury Classification. Radiographics 2023; 43:e220109. [DOI: 10.1148/rg.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dyan V. Flores
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Kawan S. Rakhra
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Zaid Jibri
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Gonzalo A. Serrano Belmar
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
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4
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Parada Avendaño I, Gil Albarova J. Fractura aislada del hueso grande asociada a quiste traumático sinovial: presentación de un caso en un niño. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introducción: Las fracturas aisladas del hueso grande son muy infrecuentes en los niños y se producen por traumatismos de alta energía. Pueden pasar desapercibidas en la valoración inicial y las radiografías solo permiten identificar las lesiones en huesos osificados, por lo que son necesarias pruebas complementarias, como la resonancia magnética, para descartar posibles lesiones del carpo asociadas, sobre todo en menores de 10 años. Se presenta el caso de una fractura aislada del hueso grande con aparición de quiste sinovial por causa traumática en un paciente pediátrico, tratado mediante inmovilización con yeso antebraquial durante cuatro semanas, con buena evolución.
Conclusión: El manejo de estos casos depende de la gravedad de la lesión y, aunque por lo común evolucionan bien con un tratamiento conservador, su diagnóstico precoz permite elegir la mejor opción yevitar posibles complicaciones, como la falta de consolidación o la necrosis avascular.Nivel de Evidencia: IV
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Munn AB, Furey AJ, Hopkins JG, Smith NC, Chang N, Squire DS. Radiographic Evaluation of Carpal Mechanics and the Scapholunate Angle in a Clenched Fist with Dynamic Computed Tomography Imaging. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:6-10. [PMID: 36704376 PMCID: PMC9870799 DOI: 10.1016/j.jhsg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The long-term consequences of injuries to the scapholunate joint can severely limit hand function, and the potential for posttraumatic deformity makes early recognition of these injuries important. The purpose of this study was to evaluate the motion of the scapholunate joint in normal wrists through the radial and ulnar deviation using novel dynamic computed tomography (CT) imaging. Methods Fifteen participants consented to have their uninjured wrists scanned. A protocol was designed to ensure adequate time, yet limited exposure, for volunteers. Participants began with the hand in a relaxed fist position and then proceeded to clench the hand in a full fist and relax. Once relaxed again, the wrist was maximally ulnarly deviated and then maximally radially deviated in a fluid motion. Dynamic CT imaging was captured throughout the range of motion. Results The scapholunate angle was measured on dynamic wrist images. The mean range of the scapholunate angle that the wrists moved through was 37.2°-45.9°, and the mean midpoint angle was 41.2° ± 0.4°. All wrists had small, measurable differences in the scapholunate angle when moving from the maximum ulnar deviation to the maximal radial deviation. The average maximum angle change through the range is 11.7°, whereas the average minimum angle change was 0.9°. Conclusions In this study, scapholunate angle calculations using dynamic wrist CT scans were within the range of accepted normal for the angle in uninjured wrists. With the increased focus on dynamic imaging for wrist motion, it may be possible to derive a standardized protocol for mapping the carpal motion that is clinically applicable and reproducible. Type of study/level of evidence Diagnostic IV.
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Affiliation(s)
- Alexandra B. Munn
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada,Corresponding author: Alexandra B. Munn, MSc, Division of Orthopedic Surgery, Memorial University of Newfoundland, H 1385, Health Sciences Centre, 300 Prince Philip Drive, St. John’s, Newfoundland and Labrador, Canada A1B 3V6.
| | - Andrew J. Furey
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - John G. Hopkins
- Division of Radiology, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Nick C. Smith
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Nicholas Chang
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Daniel S. Squire
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
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Casado A, Cuesta-Torralvo E, Pastor JF, De Diego M, Gómez M, Ciurana N, Potau JM. 3D geometric morphometric analysis of the distal radius insertion sites of the palmar radiocarpal ligaments indicates a relationship between wrist anatomy and unique locomotor behavior in hylobatids. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 178:647-654. [PMID: 36790696 DOI: 10.1002/ajpa.24568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/02/2022] [Accepted: 05/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to explore the anatomical differences in the insertion sites of the palmar radiocarpal ligaments between hylobatids and other hominoids that may be related to their different locomotor behaviors. MATERIALS AND METHODS The morphology of the insertion sites of the palmar radiocarpal ligaments was analyzed with three-dimensional geometric morphometrics (3D GM) in the distal radial epiphysis of 44 hylobatids, 25 Pan, 31 Gorilla and 15 Pongo. RESULTS Relative to other hominoids, hylobatid insertion sites of the palmar radiocarpal ligaments were relatively larger and the insertion site of the short radiolunate ligament had a palmar orientation. DISCUSSION Larger palmar radiocarpal ligaments in hylobatids can help stabilize the wrist during the radial and ulnar displacement that occurs in ricochetal brachiation, the characteristic locomotor behavior of hylobatids, and compensate for the large traction loads on the wrist during extended-elbow vertical climbing.
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Affiliation(s)
- Aroa Casado
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.,Institut d'Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), Barcelona, Spain
| | - Elisabeth Cuesta-Torralvo
- Institut d'Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), Barcelona, Spain
| | | | - Marina De Diego
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Mónica Gómez
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Neus Ciurana
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Josep Maria Potau
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.,Institut d'Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), Barcelona, Spain
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Zarenia M, Arpinar VE, Nencka AS, Muftuler LT, Koch KM. Dynamic tracking of scaphoid, lunate, and capitate carpal bones using four-dimensional MRI. PLoS One 2022; 17:e0269336. [PMID: 35653348 PMCID: PMC9162359 DOI: 10.1371/journal.pone.0269336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
A preliminary exploration of technical methodology for dynamic analysis of scaphoid, capitate, and lunate during unconstrained movements is performed in this study. A heavily accelerated and fat-saturated 3D Cartesian MRI acquisition was used to capture temporal frames of the unconstrained moving wrist of 5 healthy subjects. A slab-to-volume point-cloud based registration was then utilized to register the moving volumes to a high-resolution image volume collected at a neutral resting position. Comprehensive in-silico error analyses for different acquisition parameter settings were performed to evaluate the performance limits of several dynamic metrics derived from the registration parameters. Computational analysis suggested that sufficient volume coverage for the dynamic acquisitions was reached when collecting 12 slice-encodes at 2.5mm resolution, which yielded a temporal resolution of and 2.6 seconds per volumetric frame. These acquisition parameters resulted in total in-silico errors of 1.9°±1.8° and 3°±4.6° in derived principal rotation angles within ulnar-radial deviation and flexion-extension motion, respectively. Rotation components of the carpal bones in the radius coordinate system were calculated and found to be consistent with earlier 4D-CT studies. Temporal metric profiles derived from ulnar-radial deviation motion demonstrated better performance than those derived from flexion/extension movements. Future work will continue to explore the use of these methods in deriving more complex dynamic metrics and their application to subjects with symptomatic carpal dysfunction.
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Affiliation(s)
- Mohammad Zarenia
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
- * E-mail:
| | - Volkan Emre Arpinar
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Andrew S. Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - L. Tugan Muftuler
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kevin M. Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
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Higashigaito K, Pfirrmann CWA, Koch S, Graf D, Schweizer A, Nanz D, Rosskopf AB. Ligaments of the scapho-trapezial-trapezoidal joint: MR anatomy in asymptomatic and symptomatic individuals. Skeletal Radiol 2022; 51:637-647. [PMID: 34309690 PMCID: PMC8763724 DOI: 10.1007/s00256-021-03865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the MRI anatomy of the scapho-trapezial-trapezoidal (STT) ligament complex in asymptomatic and symptomatic individuals. MATERIAL AND METHODS In this retrospective study, STT ligament complex of 42 (male 69%, median age 37.5 years) asymptomatic (n = 25) and symptomatic (n = 17) (defined as pain described over the STT joint) individuals was examined using a high-resolution 3D proton density-weighted isovoxel sequence (MR arthrogram) with multiplanar reconstructions. Two musculoskeletal radiologists independently assessed visibility, signal intensity (SI), morphology, and thickness of the radiopalmar scapho-trapezial ligament (rpSTL), palmar scapho-capitate capsular ligament (pSCL), palmar STT capsule (pSTTC), and dorsal STT capsule (dSTTC). RESULTS Interreader agreement ranged from fair to good and intraclass correlations were good. The rpSTL was almost always visible (85.7%/80.1%; reader 1/reader 2). The pSCL and dSTTC were visible in all cases. The pSTTC was visible in only 52.4%/42.9%. Mean thickness of the rpSTL, pSCL, pSTTC, and dSTTC was 1.4 ± 0.5 mm/1.3 ± 0.5 mm, 2.8 ± 0.7 mm/2.7 ± 0.6 mm, 0.5 ± 0.5 mm/0.4 ± 0.4 mm, and 0.5 ± 0.3 mm/0.3 ± 0.3 mm. Both readers rated SI of the rpSTL significantly more often as increased in the symptomatic group (increased SI in asymptomatic group: 20%/15%; symptomatic group: 56%/50%) (p-values < 0.005). For all other ligaments, no significant difference was observed for SI between symptomatic and asymptomatic group (p-values ranging between 0.188 and 0.890). For all other ligaments, no significant differences were observed regarding ligament visibility, morphology, and thickness (p-values ranging between 0.274 and 1.000). CONCLUSION The anatomy of the STT ligament complex can consistently be visualized on high-resolution 3D MRI. Increased signal intensity of rpSTL is significantly more frequent in patients with radial-sided wrist pain.
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Affiliation(s)
- Kai Higashigaito
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland ,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian W. A. Pfirrmann
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland ,MRI Medical Radiological Institute Zurich, Zurich, Switzerland
| | - Sarah Koch
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Dimitri Graf
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Andreas Schweizer
- Handsurgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Daniel Nanz
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland
| | - Andrea B. Rosskopf
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland ,ARISTRA, Radiology, Zurich, Switzerland
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Huflage H, Luetkens KS, Conrads N, Jakubietz MG, Jakubietz RG, Schmitt R, Goertz L, Pennig L, Bley TA, Grunz JP. Assessing the scapholunate and lunotriquetral interosseous ligament in MR arthrography: Diagnostic advantages of paraxial reformatting. Eur J Radiol 2021; 142:109860. [PMID: 34284233 DOI: 10.1016/j.ejrad.2021.109860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The scapholunate (SLIL) and lunotriquetral interosseous ligament (LTIL) function as the main stabilizers of the proximal carpal row. Even with MR arthrography, component assessability is often limited in orthogonal standard planes due to their horseshoe-like shape and resulting partial volume effects. This study aims to investigate the diagnostic value of reformatting isotropic 3D sequences with respect to the anatomical orientation of the intrinsic carpal ligaments. METHOD In 110 MR arthrograms of the wrist, we investigated the diagnostic accuracy of two radiologists (R1/R2) for SLIL and LTIL injuries in orthogonal standard planes vs. ancillary angulated reformatting of isotropic 3D dual echo steady state sequence. Component assessability and diagnostic confidence were compared between datasets. RESULTS The addition of paraxial reformations improved diagnostic accuracy for lesions of the palmar (R1: 0.87 vs. 0.93; R2: 0.86 vs. 0.93; all p < 0.05) and dorsal LTIL (R1: 0.85 vs. 0.93; R2: 0.82 vs. 0.90; all p < 0.05). No significant increase in accuracy could be ascertained for palmar (R1: 0.92 vs. 0.94, p = 0.50; R2: 0.86 vs. 0.92, p = 0.07) and dorsal (R1: 0.95 vs. 0.95, p = 1.00; R2: 0.90 vs. 0.94, p = 0.29) lesions of the SLIL. Interrater reliability was almost perfect with and without angulated planes for SLIL (κ = 0.88 vs. 0.82) and LTIL assessment (κ = 0.88 vs. 0.86). For the LTIL, observer confidence and component assessability were superior with anatomical reformations available (all p < 0.05). CONCLUSIONS In contrast to SLIL injuries, diagnosis of LTIL lesions benefits from ancillary paraxial reformations of 3D sequences in MR wrist arthrography.
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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
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, 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
| | - Rafael Gregor Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, 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
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, 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
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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Guo RC, Cardenas JM, Wu CH. Triquetral Fractures Overview. Curr Rev Musculoskelet Med 2021; 14:101-106. [PMID: 33483875 PMCID: PMC7991068 DOI: 10.1007/s12178-021-09692-w] [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] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The triquetrum is the second most commonly fractured carpal bone, comprising 15-18% of all carpal bone fractures. This review summarizes the current knowledge of triquetral fractures, including the anatomy and pathophysiology, evaluation and diagnosis, treatment and management, post-treatment outcomes, and complications. RECENT FINDINGS Triquetral fractures are frequently caused by impaction of the ulnar wrist after a fall on an outstretched hand or by avulsion of attached ligaments. There are three main types of triquetral fractures: dorsal cortical fractures, triquetral body fractures, and volar cortical fractures. Dorsal cortical fractures are the most common and are usually benign, while volar cortical fractures are the least common and can be problematic. Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes. Surgical treatment is indicated for fractures with significant displacement or evidence of instability. Complications of triquetral fractures include non-union, triangular fibrocartilage complex injury, and pisotriquetral arthritis. While less common than scaphoid fractures, triquetral fractures should remain in the differential diagnosis for patients with ulnar-sided wrist pain after falling on an outstretched hand. Most triquetral fractures can be treated with immobilization, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis. Further research is needed to determine the best method of surgical treatment.
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Affiliation(s)
- Raymond C. Guo
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
| | - Justin M. Cardenas
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
| | - Chia H. Wu
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
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Abstract
Technological advances in magnetic resonance imaging (MRI) have improved radiologists' ability to evaluate wrist ligaments. MRI interpretation often guides clinical management. This article aims to review the normal and pathologic appearance of intrinsic and extrinsic wrist ligaments with a focus on MRI. Variant anatomy, imaging pearls, and clinical significance are also discussed. Special attention is paid to key wrist ligaments that play a role in carpal stability.
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Osseous Pathology on Wrist Magnetic Resonance Imaging. Top Magn Reson Imaging 2021; 29:245-261. [PMID: 33021576 DOI: 10.1097/rmr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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Multimodality Pitfalls of Wrist Imaging With a Focus on Magnetic Resonance Imaging: What the Radiologist Needs to Know. Top Magn Reson Imaging 2021; 29:263-272. [PMID: 33021577 DOI: 10.1097/rmr.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Numerous pitfalls are frequently encountered at multimodality imaging of the wrist, which may mimic various tendinous, osseous, capsuloligamentous, muscular, and neurovascular pathologic conditions. These pitfalls may be secondary to variant anatomy, artifactual due to magnetic resonance imaging or sonographic technique, or represent varying ranges of structure-specific normal including a spectrum of findings associated with aging in asymptomatic subjects. When an imaging finding of questionable significance is encountered, it is critical that the interpreting radiologist make every attempt to review any relevant clinical information in an effort to determine whether the imaging findings in question may account for the patient's presenting symptomology. In order to accurately diagnose true pathology at wrist imaging, it is imperative that the radiologist be familiar with the pitfalls discussed throughout this manuscript that may mimic disease. This familiarity will allow the radiologist to provide a more useful report for referring providers focusing on true pathology while eliminating potentially confusing or misleading findings which are inconsistent with the patient's clinical presentation.
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14
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Margulies IG, Xu H, Gopman JM, Freeman MD, Dayan E, Taub PJ, Melamed E. Narrative Review of Ligamentous Wrist Injuries. J Hand Microsurg 2021; 13:55-64. [PMID: 33867762 PMCID: PMC8041499 DOI: 10.1055/s-0041-1724224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.
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Affiliation(s)
- Ilana G Margulies
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Hope Xu
- Section of Plastic Surgery, University of Chicago, Chicago, Illinois, United States
| | - Jared M Gopman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Matthew D Freeman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eitan Melamed
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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15
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Brinkhorst M, Streekstra G, van Rosmalen J, Strackee S, Hovius S. Effects of axial load on in vivo scaphoid and lunate kinematics using four-dimensional computed tomography. J Hand Surg Eur Vol 2020; 45:974-980. [PMID: 32746687 PMCID: PMC7583439 DOI: 10.1177/1753193420943400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This in vivo study investigated the effect of axial load on lunate and scaphoid kinematics during flexion-extension and radial-ulnar deviation of the uninjured wrist using four-dimensional computed tomography. We found that applying axial load to the wrist results in a more flexed, radially deviated and pronated position of the lunate and scaphoid during flexion-extension of the wrist compared with when no load is applied. A larger pronation and supination range of the lunate and scaphoid was seen when the wrist was flexed and extended under axial load, whereas a larger flexion and extension range of the lunate and scaphoid occurred during radial-ulnar deviation of the wrist when axial load was applied.
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Affiliation(s)
- Michelle Brinkhorst
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands,Michelle Brinkhorst, PO Box 2040, Room Na-2206, 3000 CA Rotterdam, The Netherlands.
| | - Geert Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, The Netherlands,Department of Radiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Simon Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Steven Hovius
- Xpert Clinic, Hand and Wrist Clinic, Nijmegen, The Netherlands,Department of Plastic, Reconstructive and Hand Surgery, Radboudumc, Nijmegen, The Netherlands
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16
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Abstract
The anatomy of the wrist and hand is complex and contains numerous small structures. Magnetic resonance imaging (MRI) is often an ideal imaging modality in the assessment of various traumatic and pathologic conditions of this region, and it is frequently performed after initial radiographs. In this manuscript we describe the normal anatomy, imaging techniques, and MRI findings of various traumatic and pathologic conditions of the wrist and hand including occult fractures, osteonecrosis, ligamentous and tendon injuries, and entrapment neuropathies.
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17
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Imaging evaluation of traumatic carpal instability. Emerg Radiol 2020; 28:349-359. [PMID: 32808235 DOI: 10.1007/s10140-020-01839-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To review the epidemiology, pertinent wrist anatomy, classification system, and emergent imaging evaluation of carpal instability with a focus on radiographic assessment of instability. METHODS A review of current literature on carpal instability was performed with summary presentation of carpal instability epidemiology, carpal anatomy, imaging evaluation, and classification with imaging evaluation focused on diagnosis in the emergency setting. RESULTS Carpal instability is a common pathology in falls on outstretched hand and is likely underdiagnosed due to instability being occult or demonstrating subtle malalignment on static imaging of the wrist. While there is a complex network of intrinsic and extrinsic ligaments contributing to carpal instability, a detailed knowledge of these ligaments is not necessary for radiologists to make an accurate diagnosis in the emergency setting, as identification and classification of carpal instability is based on identification of carpal malalignment patterns on radiography as opposed to identification of specific ligament injuries on advanced imaging. The Mayo classification is the most widely used classification system, which divides carpal instability into four categories: dissociative, non-dissociative, complex, and adaptive. Understanding this classification system allows radiologists to successfully classify almost all carpal instability injuries they will encounter, even in the setting of unusual or rare instability patterns. CONCLUSION In working with the treating clinician, it is essential that the emergency radiologist is comfortable with identifying and classifying carpal instability. This will ensure prompt treatment of seemingly benign injuries and those that require intervention, surgical or otherwise, improving the likelihood of a good outcome.
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18
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Clinical Applications of Imaging Modalities of the Carpal Joint in Dogs with Particular Reference to the Carpal Canal. J Vet Res 2020; 64:169-174. [PMID: 32258814 PMCID: PMC7105982 DOI: 10.2478/jvetres-2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/19/2020] [Indexed: 01/13/2023] Open
Abstract
The structure of the canine carpal joint is complex. This small joint consists of articulations that include the antebrachiocarpal, middle, carpometacarpal, and intercarpal joint surfaces. A large number of ligaments and tendons support and stabilise the carpus in dogs. Many injuries of this joint in dogs are not correctly recognised, diagnosed, or treated due to the limited use of diagnostic imaging methods. Radiography, the most common of them, has extensive application in diagnosing the causes of lameness in small animals. Other techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging visualise other joint structures and surrounding soft tissues. However, these imaging modalities are rarely used to diagnose diseases and injuries of the canine carpus at present. The main reason for this is the small amount of research carried out and the lack of a properly described methodology for the use of imaging techniques. The wide use of all diagnostic imaging tools in the diagnosis of diseases and injuries of the wrist joint in humans shows that conducting studies on dogs could expand current knowledge. The use of these techniques in veterinary medicine could facilitate diagnosis and subsequent therapy of carpal disorders in dogs. MRI is the most frequently used imaging method in human medicine for visualisation of abnormalities of joints. This method could become a valuable part of the detection of inflammatory, traumatic, and degenerative diseases of the carpal joint in dogs.
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19
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Weintraub MD, Hansford BG, Stilwill SE, Allen H, Leake RL, Hanrahan CJ, Chan BY, Soltanolkotabi M, Kobes P, Mills MK. Avulsion Injuries of the Hand and Wrist. Radiographics 2020; 40:163-180. [DOI: 10.1148/rg.2020190085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael D. Weintraub
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Barry G. Hansford
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Sarah E. Stilwill
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Richard L. Leake
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Christopher J. Hanrahan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Maryam Soltanolkotabi
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Patrick Kobes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Megan K. Mills
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
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20
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Lim W, Saifuddin A. Review article: the differential diagnosis of bone marrow edema on wrist MRI. Skeletal Radiol 2019; 48:1525-1539. [PMID: 30903260 DOI: 10.1007/s00256-019-03204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 02/02/2023]
Abstract
There is a large variety of conditions that can result in 'bone marrow edema' or 'bone marrow lesions' (BML) in the wrist on magnetic resonance imaging (MRI). The combination of clinical history and the distribution of the BML can serve as a valuable clue to a specific diagnosis. This article illustrates the different patterns of BML in the wrist to serve as a useful guide when reviewing wrist MRI studies. Imaging artefacts will also be briefly covered.
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Affiliation(s)
- WanYin Lim
- Dr Jones and Partners Medical Imaging, 226 Greenhill Road, Eastwood, SA, 5063, Australia. .,Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia.
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Everlight Radiology, Level 6 West, Euston Road, London, NW1 3AX, UK
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21
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Casado A, Punsola V, Gómez M, de Diego M, Barbosa M, de Paz FJ, Pastor JF, Potau JM. Three-dimensional geometric morphometric analysis of the distal radius insertion sites of the palmar radiocarpal ligaments in hominoid primates. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 170:24-36. [PMID: 31215639 DOI: 10.1002/ajpa.23885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/14/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To identify anatomic differences in the insertion sites of the palmar radiocarpal ligaments in different species of hominoid primates that may be related to their different types of locomotion. MATERIALS AND METHODS We have used three-dimensional geometric morphometrics (3D GM) to analyze the distal radius ligament insertion sites in 31 Homo sapiens, 25 Pan troglodytes, 31 Gorilla gorilla, and 15 Pongo pygmaeus. We have also dissected the radioscaphocapitate (RSC), long radiolunate (LRL) and short radiolunate (SRL) ligaments in six H. sapiens and five P. troglodytes to obtain quantitative values that were then compared with the results of the 3D GM analysis. RESULTS H. sapiens had a relatively larger insertion site of the RSC + LRL ligament than the other hominoid primates. P. pygmaeus and P. troglodytes had a relatively large SRL ligament insertion site with a palmar orientation. In G. gorilla, the two ligament insertion sites were relatively smaller and the SRL insertion site had an ulnopalmar orientation. DISCUSSION The morphological differences observed can be related to the types of locomotion used by the different species and to quantitative data obtained from the dissection of ligaments in H. sapiens and P. troglodytes. 3D GM analysis of ligament insertion sites can help in interpreting the types of locomotion used by extinct hominoid primates through the analysis of preserved fossilized fragments of the distal radius.
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Affiliation(s)
- Aroa Casado
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Vicenç Punsola
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Mónica Gómez
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Marina de Diego
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Mercedes Barbosa
- Department of Anatomy and Radiology, University of Valladolid, Valladolid, Spain
| | - Félix J de Paz
- Department of Anatomy and Radiology, University of Valladolid, Valladolid, Spain
| | - Juan F Pastor
- Department of Anatomy and Radiology, University of Valladolid, Valladolid, Spain
| | - Josep M Potau
- Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
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22
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Gulati A, Wadhwa V, Ashikyan O, Cerezal L, Chhabra A. Current perspectives in conventional and advanced imaging of the distal radioulnar joint dysfunction: review for the musculoskeletal radiologist. Skeletal Radiol 2019; 48:331-348. [PMID: 30171275 DOI: 10.1007/s00256-018-3042-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 02/02/2023]
Abstract
Distal radioulnar joint (DRUJ) dysfunction is a common cause of ulnar sided wrist pain. Physical examination yields only subtle clues towards the underlying etiology. Thus, imaging is commonly obtained towards an improved characterization of DRUJ pathology, especially multimodality imaging, which is frequently resorted to arrive at an accurate diagnosis. With increasing use of advanced MRI and CT techniques, DRUJ imaging has become an important part of a musculoskeletal radiologist's practice. This article discusses the normal anatomy and biomechanics of the DRUJ, illustrates common clinical abnormalities, and provides a comprehensive overview of the imaging evaluation with an insight into the role of advanced cross-sectional modalities in this domain.
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Affiliation(s)
| | - Vibhor Wadhwa
- Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Luis Cerezal
- Radiology, Diagnóstico Médico Cantabria, Santander, Spain
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA. .,Orthopaedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Johns Hopkins University, Baltimore, MD, USA.
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23
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Porter IR, Pownder SL, McDonough SP, Potter HG, Hayashi K. Nonarticular osseous cyst-like lesions of the intermedioradial carpal bone may be incidental magnetic resonance imaging findings in dogs. Vet Radiol Ultrasound 2018; 59:715-720. [PMID: 30395383 DOI: 10.1111/vru.12658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/14/2018] [Accepted: 04/02/2018] [Indexed: 11/27/2022] Open
Abstract
As magnetic resonance imaging (MRI) becomes more readily available and more frequently utilized in the assessment of canine carpal lameness, both normal variations and early pathologic conditions must be recognized to optimize patient care and provide accurate diagnosis. On cross sectional studies of the canine carpus, cyst-like lesions have been detected at the dorsolateral aspect of the intermedioradial carpal bone. The cross-sectional imaging and histologic properties of these lesions have not been described. The purpose of this observational study is to evaluate the MRI and histologic features of these cyst-like lesions in a cohort of clinically sound dogs. It was hypothesized that the lesions would show features similar to intraosseous ganglion cysts of the human wrist. Twenty-five cadaveric canine carpi were obtained and a total of 13 lesions were detected on MRI. Based on MRI, six carpi with lesions of varying size and one normal carpus were submitted for histological evaluation. Five of the abnormal carpi had nonarticular cyst-like lesions; one specimen with a positive magnetic resonance image for a cyst-like lesion had no cyst-like lesion on histology. Conspicuity of a medium-size lesion as evaluated on radiographs was poor. Given the presence of these nonarticular cyst-like lesions in a population of clinically sound patients, their clinical importance is uncertain. The development of these lesions may relate to altered mechanics or genetic predispositions, requiring additional study.
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Affiliation(s)
- Ian R Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853
| | - Sarah L Pownder
- MRI Laboratory, Hospital for Special Surgery, New York, NY, 10021
| | - Sean P McDonough
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853
| | - Hollis G Potter
- MRI Laboratory, Hospital for Special Surgery, New York, NY, 10021
| | - Kei Hayashi
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853
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24
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Kelly PM, Hopkins JG, Furey AJ, Squire DS. Dynamic CT Scan of the Normal Scapholunate Joint in a Clenched Fist and Radial and Ulnar Deviation. Hand (N Y) 2018; 13:666-670. [PMID: 28850255 PMCID: PMC6300186 DOI: 10.1177/1558944717726372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Injuries to the scapholunate can have severe long-term effects on the wrist. Early detection of these injuries can help identify pathology. The purpose of this study was to evaluate the motions of the scapholunate joint in normal wrists in a clenched fist and through radial and ulnar deviation using novel dynamic computed tomography (CT) imaging. METHODS Fifteen participants below 40 years of age consented to have their wrist scanned. Eight participants were randomized to have the right wrist scanned and 7 the left wrist. Volunteers were positioned at the back of the gantry with the wrist placed on the table, palmar side down. Participants began with the hand in a relaxed fist position and then proceeded through an established range of motion protocol. Dynamic CT imaging was captured throughout the range of motion. RESULTS The movement in the healthy scapholunate joint through a clenched fist and radial and ulnar deviation is minimal. The averages were 1.19, 1.01, and 0.95 mm, representing the middle, dorsal, and volar measurements, respectively. CONCLUSIONS This novel dynamic CT scan of the wrist is a user-friendly way of measuring of the scapholunate distance, which is minimal in the normal wrist below 40 years of age.
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Affiliation(s)
- Paul M. Kelly
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada,Paul M. Kelly, Division of Orthopedic Surgery, Memorial University of Newfoundland, H 1385, Health Sciences Centre, 300 Prince Philip Drive, St. John’s, Newfoundland and Labrador, Canada A1B 3V6.
| | - John G. Hopkins
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Andrew J. Furey
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Daniel S. Squire
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
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25
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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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26
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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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27
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Gitto S, Messina C, Mauri G, Aliprandi A, Sardanelli F, Sconfienza LM. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple. Eur J Radiol 2016; 87:20-35. [PMID: 28065372 DOI: 10.1016/j.ejrad.2016.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/28/2016] [Accepted: 12/01/2016] [Indexed: 01/29/2023]
Abstract
Wrist ligaments are crucial structures for the maintenance of carpal stability. They are classified into extrinsic ligaments, connecting the carpus with the forearm bones or distal radioulnar ligaments, and intrinsic ligaments, entirely situated within the carpus. Lesions of intrinsic and extrinsic ligaments of the wrist have been demonstrated to occur largely, mostly in patients with history of trauma and carpal instability, or rheumatoid arthritis. Ultrasound allows for rapid, cost-effective, non-invasive and dynamic evaluation of the wrist, and may represent a valuable diagnostic tool. Although promising results have been published, ultrasound of wrist ligaments is not performed in routine clinical practice, maybe due to its technical feasibility regarded as quite complex. This review article aims to enlighten readers about the normal sonographic appearance of intrinsic and extrinsic carpal ligaments, and describe a systematic approach for their sonographic assessment with detailed anatomic landmarks, dynamic manoeuvres and scanning technique.
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Affiliation(s)
- Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Giovanni Mauri
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy; Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141 Milano, Italy
| | - Alberto Aliprandi
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy; Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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Ramamurthy NK, Chojnowski AJ, Toms AP. Imaging in carpal instability. J Hand Surg Eur Vol 2016; 41:22-34. [PMID: 26586689 DOI: 10.1177/1753193415610515] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
Carpal instability is a complex and heterogeneous clinical condition. Management requires accurate identification of structural injury with an understanding of the resultant movement (kinematic) and load transfer (kinetic) failure. Static imaging techniques, such as plain film radiography, stress views, ultrasound, magnetic resonance, MR arthrography and computerized tomography arthrography, may accurately depict major wrist ligamentous injury. Dynamic ultrasound and videofluoroscopy may demonstrate dynamic instability and kinematic dysfunction. There is a growing evidence base for the diagnostic accuracy of these techniques in detecting intrinsic ligament tears, but there are limitations. Evidence of their efficacy and relevance in detection of non-dissociative carpal instability and extrinsic ligament tears is weak. Further research into the accuracy of existing imaging modalities is still required. Novel techniques, including four-dimensional computerized tomography and magnetic resonance, can evaluate both cross-sectional and functional carpal anatomy. This is a narrative review of level-III studies evaluating the role of imaging in carpal instability.
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Affiliation(s)
- N K Ramamurthy
- Department of Radiology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A J Chojnowski
- Department of Orthopaedic Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Chang CY, Huang AJ, Bredella MA, Kattapuram SV, Torriani M. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology. Skeletal Radiol 2014; 43:793-800. [PMID: 24595441 DOI: 10.1007/s00256-014-1845-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/20/2014] [Accepted: 02/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. MATERIALS AND METHODS We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. RESULTS There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P < 0.0001; R1 and R2 averaged data, P < 0.0001) and ECU tendon subluxation (P = 0.001; P = 0.0001; P < 0.0001). In subjects with ECU tendon subluxation there was also a trend toward a shorter length (P = 0.3; P <0.0001; P = 0.001) and a shallower ECU groove (P = 0.01; P = 0.03; P = 0.01; R1 and R2 averaged data with Bonferroni correction, P = 0.08). ECU groove depth (P = 0.6; P = 0.8; P = 0.9) and groove length (P = 0.1; P = 0.4; P = 0.7) showed no significant correlation with ECU tendon pathology, and length of the ulnar styloid process showed no significant correlation with ECU tendon pathology (P = 0.2; P = 0.3; P = 0.2) or subluxation (P = 0.4; P = 0.5; P = 0.5). Inter-observer agreement (ICC) was >0.64 for all parameters. CONCLUSION Distal ulnar morphology may be associated with ECU tendon abnormalities.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts, General Hospital and Harvard Medical School, Boston, MA, USA,
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