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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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Flores DV, Murray T, Jacobson JA. Diagnostic and Interventional US of the Wrist and Hand: Quadrant-based Approach. Radiographics 2023; 43:e230046. [PMID: 37498783 DOI: 10.1148/rg.230046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Diagnostic and interventional US of the wrist and hand can be challenging due to the small size and superficial location of structures and various disorders that need to be considered. A quadrant-based approach (volar, ulnar, dorsal, and radial) provides a rational method for performing a focused examination and joint positioning during both diagnostic imaging and intervention. Volar wrist disorders primarily involve the median nerve and the digital flexor system comprised of the flexor tendons and pulleys. The ulnar nerve and extensor carpi ulnaris tendon are chiefly responsible for ulnar-sided wrist pain. The differential diagnosis for dorsal-sided symptoms typically involves the extensor tendon compartments and includes distal intersection syndrome, extensor pollicis longus tear, and digital extensor apparatus injury. The soft-tissue ganglion is the most common abnormality in the dorsal wrist, typically associated with wrist ligaments or joint capsule. Radial-sided pain may be secondary to de Quervain tenosynovitis and must be differentiated from the more proximal intersection syndrome. US is an important tool for assessing the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb and differentiating between displaced and nondisplaced tears, thereby influencing management. Despite the complexity of the anatomy and potential pathologic features within the wrist, a focused quadrant-based examination can permit the sonologist to focus on the structures of relevance. In conjunction with a systematic approach, this can aid in precise and efficient diagnostic scanning and intervention of the wrist and hand. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Timothy Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Jon A Jacobson
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
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Handschak T, Hofmann G, Braunschweig R, Tamouridis G, Siemers F. [Establishing a standardized diagnostic Procedure for sonographic Imaging and Evaluation of the scapholunate Ligament]. HANDCHIR MIKROCHIR P 2022; 54:28-37. [PMID: 35168267 DOI: 10.1055/a-1718-3552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ultrasound has not yet been established in the diagnostic workup of scapholunate ligament lesions. We aimed to develop a standardised examination procedure to visualise and evaluate the SL ligament. PATIENTS AND METHODS Forty patients (70 hands) were examined prospectively with ultrasonography and the results were compared with arthroscopy and MRI findings. We studied the visibility of the SL ligament and the SL distance on side-to-side comparison and performed a method comparison between MRI/arthroscopy and ultrasound, testing for distinction and accordance. Cut-off values for the SL distance indicating a lesion were determined and all parameters were used for developing a score. RESULTS An intact ligament appears as a hyperechogenic, fibrillary structure and shows discontinuity or a hypoechogenic space when injured. An intact ligament was visible dorsally in 89.6 % and palmarly in 83.3 %. The SL distance for an intact ligament was 5/2/5.1 mm for the dorsal/middle/palmar aspect (range 3.2-6.7/0.9-4/3.1-7.8 mm) and 6.4/3/6.3 mm (range 5-9.4/2-6.2/4-9.3 mm) for a lesion. The difference between the right and left hand with an intact ligament was a maximum of 2.1/1.1/1.8 mm, an average of 0.4/0.2/0.2 mm; in case of an injury, the maximum difference was 1.2/0.9/1.1 mm. Distance values for radial and ulnar deviation were physiological but partly unpredictable. The cut-off values determined for a lesion are 5.05 mm for the dorsal aspect (sensitivity/specificity 0.95/0.60), 1.95 mm for the middle (1/0.62) and 6.15 mm for the palmar aspect (0.55/0.85). The created sonographic SL ligament score has a high AUC (area under the curve) of 0.93, a sensitivity of 85 % and a specificity of 90 %. CONCLUSION The parameters, especially when combined to a score, allow to state whether the SL ligament is intact or not. Ultrasound can, therefore, be recommended as a diagnostic and screening method for an SL ligament lesion und should be used as a routine tool. The criteria must be checked from a perspective with high case numbers.
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Affiliation(s)
- Tino Handschak
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle Unfallchirurgie
| | - Gunther Hofmann
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle Unfallchirurgie
| | - Rainer Braunschweig
- Deutsche Röntgen Gesellschaft Arbeitsgemeinschaft Muskulo-Skelettale-Diagnostik
| | | | - Frank Siemers
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle Unfallchirurgie
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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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Zhang A, Falkowski AL, Jacobson JA, Kim SM, Koh SH, Gaetke-Udager K. Sonography of Wrist Ganglion Cysts: Which Location Is Most Common? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2155-2160. [PMID: 30592543 DOI: 10.1002/jum.14912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The literature states that wrist ganglion cysts are most commonly dorsal; however, our experience suggests a volar location is more common. The purpose of this study was to identify the locations of ganglion cysts of the wrist as imaged with sonography. METHODS After Institutional Review Board approval with informed consent waived, retrospective review of wrist sonography reports from January to April 2016 was completed. Only patients who had a comprehensive evaluation that included the dorsal and volar wrist were included. Ultrasound images were reviewed to characterize wrist ganglion cysts. RESULTS The study group consisted of 98 subjects (78% female, 22% male) (median age, 51 years; range 13-79) with 124 wrist ganglion cysts, where 69% (86 of 124) were volar and 31% (38 of 124) were dorsal. Ganglion cysts were located between the radial artery and flexor carpi radialis in 63% (78 of 124), followed by a dorsal location superficial to the scapholunate ligament in 20% (25 of 124), other dorsal locations in 11% (13 of 124), and other volar locations in 6% (8 of 124). With dorsal ganglion cysts, the scapholunate ligament when imaged appeared normal in 91% (20 of 22). Ganglion cysts were multilocular/multilobular in all subjects. CONCLUSIONS The most common location for wrist ganglion cysts is in the volar wrist, particularly between the radial artery and flexor carpi radialis tendon, appearing multilocular or multilobular with a mean largest dimension of 1.0 cm. Given the propensity of ganglion cysts to occur at this site, attention to this area when imaging the wrist with sonography or magnetic resonance imaging should be considered.
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Affiliation(s)
- Andrew Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna L Falkowski
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung Hye Koh
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, Hallym Sacred Heart Hospital, Hallym University, College of Medicine, Gyeonggi-do, South Korea
| | - Kara Gaetke-Udager
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
BACKGROUND The anatomy of the scapholunate interosseous ligament (SLIL) has been described qualitatively in great detail, with recognition of the dorsal component's importance for carpal stability. The purpose of this study was to define the quantitative anatomy of the dorsal SLIL and to assess the use of high-frequency ultrasound to image the dorsal SLIL. METHODS We used high-frequency ultrasound imaging to evaluate 40 wrists in 20 volunteers and recorded the radial-ulnar (length) and dorsal-volar (thickness) dimensions of the dorsal SLIL and the dimensions of the scapholunate interval. We assessed the use of high-frequency ultrasound by comparing the length and thickness of the dorsal SLIL on ultrasound evaluation and open dissection of 12 cadaveric wrists. Student's t test was used to assess the relationship between measurements obtained on cadaver ultrasound and open dissection. RESULTS In the volunteer wrists, the mean dorsal SLIL length was 7.5 ± 1.4 mm and thickness was 1.8 ± 0.4 mm; the mean scapholunate interval was 5.0 mm dorsally and 2.5 mm centrally. In the cadaver wrists, there was no difference in dorsal SLIL length or thickness between ultrasound and open dissection. CONCLUSIONS The dorsal SLIL is approximately 7.5 mm long and 1.8 mm thick. These parameters may be useful in treatment of SLIL injuries to restore the native anatomy. High-frequency ultrasound is a useful imaging technique to assess the dorsal SLIL, although further study is needed to assess the use of high-frequency ultrasound in detection of SLIL pathology.
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Affiliation(s)
- M. Claire Manske
- Shriners Hospitals for Children–Northern California, Sacramento, USA
- M. Claire Manske, Department of Orthopedic Surgery, Shriners Hospitals for Children–Northern California, 2425 Stockton Boulevard, Sacramento, CA 95817, USA.
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Imaging of Wrist Injuries: A Standardized US Examination in Daily Practice. J Belg Soc Radiol 2018. [DOI: 10.5334/jbsr.1319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Imaging of Wrist Injuries: A Standardized US Examination in Daily Practice. J Belg Soc Radiol 2018; 102:9. [PMID: 30039023 PMCID: PMC6032708 DOI: 10.5334/jbr-btr.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The keys to successful ultrasonography (US) of the wrist include knowledge of the relevant anatomy and understanding the biomechanical aspects. A wide spectrum of pathological findings including bone fractures (scaphoid, triquetrum) and ligament lesions (dorsal intercarpal and radiocarpal ligaments, scapholunate ligament) can be caused by an identical traumatic mechanism determined on the basis of the position of wrist at the time of injury. In the setting of wrist trauma, an early diagnosis can minimize the potential for inappropriate or delayed treatment. We describe a practical radiological approach by using a standardized imaging protocol: standard radiographs (four views) associated with an US examination focused on seven landmarks. If there is discordance between clinical and radiological features or if the diagnosis of a disruption of the scapholunate ligament remains uncertain, additional cross-sectional imaging (MRI or CT arthrogaphy) should be performed.
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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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Abstract
OBJECTIVE The article reviews a select group of traumatic upper extremity injuries that can be easily misinterpreted on radiographs. CONCLUSION The awareness of these specific injuries and an understanding of their underlying pathophysiology and the role that radiographs can play in their evaluation will give the reader the best opportunity to make the important imaging findings and guide appropriate treatment.
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Spectrum of Carpal Dislocations and Fracture-Dislocations: Imaging and Management. AJR Am J Roentgenol 2014; 203:541-50. [DOI: 10.2214/ajr.13.11680] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skeletal Radiol 2013; 42:1277-85. [PMID: 23812413 DOI: 10.1007/s00256-013-1666-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/22/2013] [Accepted: 05/28/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE This study compares the diagnostic performance of multidetector CT arthrography (CTA), conventional 3-T MR and MR arthrography (MRA) in detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist. MATERIALS AND METHODS Ten cadaveric wrists of five male subjects with an average age 49.6years (range 26-59years) were evaluated using CTA, conventional 3-T MR and MRA. We assessed the presence of scapholunate ligament (SLL), lunotriquetral ligament (LTL), and TFCC tears using a combination of conventional arthrography and arthroscopy as a gold standard. All images were evaluated in consensus by two musculoskeletal radiologists with sensitivity, specificity, and accuracy being calculated. RESULTS Sensitivities/specificity/accuracy of CTA, conventional MRI, and MRA were 100%/100%/100%, 66%/86%/80%, 100%/86%/90% for the detection of SLL tear, 100%/80%/90%, 60%/80%/70%, 100%/80%/90% for the detection of LTL tear, and 100%/100%/100%, 100%/86%/90%, 100%/100%/100% for the detection of TFCC tear. Overall CTA had the highest sensitivity, specificity, and accuracy among the three investigations while MRA performed better than conventional MR. CTA also had the highest sensitivity, specificity, and accuracy for identifying which component of the SLL and LTL was torn. Membranous tears of both SLL and LTL were better visualized than dorsal or volar tears on all three imaging modalities. CONCLUSION Both CT and MR arthrography have a very high degree of accuracy for diagnosing tears of the SLL, LTL, and TFCC with both being more accurate than conventional MR imaging.
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Reckelhoff KE, Clark TB, Kettner NW. The Sonographic Squeeze Test: Assessing the Reliability of the Dorsal Scapholunate Ligament. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kolios L, Kotsougiani D, Hirche C, Lehnhardt M. Ultrasound in hand and wrist: approach for a standardized examination. Expert Rev Med Devices 2013; 10:471-6. [PMID: 23895074 DOI: 10.1586/17434440.2013.811840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
New very high-frequency ultrasound probes allow highly detailed imaging of superficial structures and thus are especially suitable for examination of the hand. For successful application, specific knowledge and experience as well as standardized examination techniques are required. Based on 11 determined sections of the flexor and extensor side of the hand, the authors present one approach to a standardized ultrasound examination allowing a quick view of all structures. An additional presentation of the most typical traumatic and degenerative disease patterns underlines the potency of this examination technique. With adequate equipment, training and expertise, ultrasound should be regarded as the first-line imaging modality for the assessment of a wide range of pathological conditions affecting the wrist and hand. An exact knowledge of the anatomical relation of the structures to each other gained from ultrasound experience is equally useful for following surgery of the cases.
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Affiliation(s)
- Leila Kolios
- Department of Hand, Plastic and Reconstructive Surgery, Burn Care Unit, University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany.
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Choi YS, Lee YH, Kim S, Cho HW, Song HT, Suh JS. Four-dimensional real-time cine images of wrist joint kinematics using dual source CT with minimal time increment scanning. Yonsei Med J 2013; 54:1026-32. [PMID: 23709441 PMCID: PMC3663247 DOI: 10.3349/ymj.2013.54.4.1026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To validate the feasibility of real time kinematography with four-dimensional (4D) dynamic functional wrist joint imaging using dual source CT. MATERIALS AND METHODS Two healthy volunteers performed radioulnar deviation and pronation- supination wrist motions for 10 s and 4 s per cycle in a dual source CT scanner. Scan and reconstruction protocols were set to optimize temporal resolution. Cine images of the reconstructed carpal bone of the moving wrist were recorded. The quality of the images and radiation dosage were evaluated. RESULTS The 4D cine images obtained during 4 s and 10 s of radioulnar motion showed a smooth stream of movement with good quality and little noise or artifact. Images from the pronation-supination motion showed noise with a masked surface contour. The temporal resolution was optimized at 0.28 s. CONCLUSION Using dual source CT, 4D cine images of in vivo kinematics of wrist joint movement were obtained and found to have a shorter scan time, improved temporal resolution and lower radiation dosages compared with those previously reported.
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Affiliation(s)
- Yoon Seong Choi
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Woo Cho
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Taek Song
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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Orlandi D, Fabbro E, Ferrero G, Martini C, Lacelli F, Serafini G, Silvestri E, Sconfienza LM. High-resolution ultrasound of the extrinsic carpal ligaments. J Ultrasound 2012; 15:267-72. [PMID: 23730393 DOI: 10.1016/j.jus.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.
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Affiliation(s)
- D Orlandi
- Scuola di Specializzazione in Radiodiagnostica, Dipartimento di Medicina Interna, Università degli Studi di Genova, Italy
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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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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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Bihan M, Pesquer L, Meyer P, Paris G, Rousvoal A, Bouche G, Tasu JP. [High resolution sonography of the dorsal radiocarpal and intercarpal ligaments: findings in healthy subjects with anatomic correlation to cadaveric wrists]. ACTA ACUST UNITED AC 2009; 90:813-7. [PMID: 19752786 DOI: 10.1016/s0221-0363(09)73212-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the value of ultrasound (US) imaging of the dorsal radiocarpal and intercarpal ligaments of the wrist, after characterization of their imaging features on cadaveric specimen. MATERIALS AND METHODS Two wrist dissections of fresh cadaver were performed. The orientations and the osseous insertions of the ligaments were clarified, allowing development of an US examination protocol. Then, forty wrists of asymptomatic volunteers were analyzed prospectively with US. The visibility and thickness of both ligaments were estimated at their midpoint and at their osseous insertions. RESULTS The dorsal radiocarpal and intercarpal ligaments were visualized as thin, hyperechoic and fibrillar structures, extending between their respective osseous insertions. The mid portions of the ligaments were visible at all volunteers. The osseous insertions were completely or partially visible in 90% of cases, except for the radial insertion of the dorsal radiocarpal ligament, visible in 77.5% of cases. CONCLUSION US, based on good anatomical knowledge and a standardized protocol, which we describe in this work, enables evaluation of the dorsal radiocarpal and intercarpal ligaments of the wrist.
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Affiliation(s)
- M Bihan
- Service de Radiologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers.
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Harish S, O'Neill J, Finlay K, Jurriaans E, Friedman L. Ultrasound of Wrist Pain. Curr Probl Diagn Radiol 2009; 38:111-25. [DOI: 10.1067/j.cpradiol.2008.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hagert E, Persson JKE, Werner M, Ljung BO. Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. J Hand Surg Am 2009; 34:642-51. [PMID: 19249163 DOI: 10.1016/j.jhsa.2008.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/26/2008] [Accepted: 12/02/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Recent publications on the sensory innervation of wrist ligaments have challenged our understanding of ligaments as mere passive restraints in wrist stability. Mechanoreceptors in ligaments have a role in signaling joint perturbations, in which the afferent information is believed to influence periarticular muscles. The scapholunate interosseous ligament is one of the most richly innervated ligaments in the wrist. The purpose of our study was to investigate the possible existence of a wrist proprioceptive reflex, by which afferent information elicited in the scapholunate interosseous ligament was hypothesized to influence the muscles moving the wrist joint. METHODS Nine volunteers (4 women and 5 men; mean age, 26 years; range, 21-28 years) participated in this study. Using ultrasound guidance, a fine-wire electrode was inserted into the dorsal scapholunate interosseous ligament and stimulated with four 1-ms pulses at 200 Hz. Electromyographic activities in extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles were recorded using surface electrodes with the wrist actively positioned in isometric extension, flexion, and radial and ulnar deviation. The average EMGs from 30 consecutive stimulations were rectified and analyzed using the Student's t-test to compare the prestimulus (t(1)) and poststimulus (t(2)) EMG activities. RESULTS Statistically significant changes in poststimulus EMG activity (t(1)- t(2)) were observed at various time intervals. Within 20 ms, an excitation was seen in the flexor carpi radialis and flexor carpi ulnaris in extension, radial and ulnar deviation, and in extensor carpi radialis brevis in flexion. Co-contractions between agonist and antagonist muscles were observed, with peaks around 150 ms after stimulus. CONCLUSIONS We present evidence of wrist ligamento-muscular reactions. The early-onset reactions may serve in a joint-protective manner, and later co-contractions indicate a supraspinal control of wrist neuromuscular stability. These findings contribute new information to the physiologic functions of the wrist joint, which may further our understanding of dynamic wrist stability and serve as a foundation for future studies on proprioceptive dysfunctions after wrist ligament injuries.
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Affiliation(s)
- Elisabet Hagert
- Department of Clinical Science and Education, Section of Hand Surgery, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
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Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 2009; 192:80-5. [PMID: 19098183 DOI: 10.2214/ajr.08.1089] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study assesses the sensitivity and specificity of MRI at 3 T compared with arthroscopy for detection of intrinsic wrist ligament and triangular fibrocartilage complex (TFCC) tears. MATERIALS AND METHODS MR wrist images in 300 consecutive patients underwent consensus review by two radiologists without knowledge of arthroscopy findings. Forty-nine of 300 patients underwent arthroscopy. Thirty-five of these 49 patients also underwent MR arthrography. Scans were assessed for full-thickness scapholunate, lunatotriquetral, or TFCC tears. After consensus review of MR images, arthroscopy results were compared with MR interpretations. RESULTS Of the 49 patients who underwent arthroscopy, 22 had TFCC tears, 18 had scapholunate tears, and 11 had lunatotriquetral tears (51 total tears at arthroscopy). Nineteen of 22 TFCC tears, 16 of 18 scapholunate tears, and nine of 11 lunatotriquetral tears seen at arthroscopy were seen on MRI. Four patients had both a TFCC tear and a lunatotriquetral ligament tear. One patient had a scapholunate ligament tear and a TFCC tear. There were no false-positive readings on MRI compared with arthroscopy. MR sensitivity for detection of TFCC tears was 86%, for detection of scapholunate tears was 89%, and for detection of lunatotriquetral tears was 82%. MR specificity for detection of tears was 100%. MR arthrography sensitivity for detection of ligament and TFCC tears was 100%. There were three patients in whom contrast media passed between joint spaces without an anatomic abnormality seen. These patients underwent arthroscopy with no tears seen. CONCLUSION MRI at 3 T is sensitive and specific for detection of wrist ligament tears. MR arthrography is more sensitive for ligament evaluation but can result in false-positive findings because of microperforations.
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Lacelli F, Muda A, Sconfienza LM, Schettini D, Garlaschi G, Silvestri E. High-resolution ultrasound anatomy of extrinsic carpal ligaments. Radiol Med 2008; 113:504-16. [DOI: 10.1007/s11547-008-0269-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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Taljanovic MS, Sheppard JE, Jones MD, Switlick DN, Hunter TB, Rogers LF. Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk: initial experience and correlation with arthrography and magnetic resonance arthrography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:179-191. [PMID: 18204008 DOI: 10.7863/jum.2008.27.2.179] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the utility of sonography and sonoarthrography in evaluation of dorsal bands of the scapholunate ligament (SLL), lunotriquetral ligament (LTL), and triangular fibrocartilage (TFC) disk in correlation with arthrography and magnetic resonance arthrography (MRA). METHODS High-resolution sonography of the SLL, LTL, and TFC disk was performed on symptomatic wrists in 16 patients referred by a hand surgeon for MRA of the symptomatic wrists. All patients then underwent arthrography and an MRA study of the same wrist. After MRA, sonography was repeated. The imaging findings of these different techniques were then compared. Four patients (25%) underwent surgery of their wrists. In these 4 patients, the surgical and imaging findings were correlated. RESULTS For the SLL, the results were concordant for all imaging modalities in 15 patients (93.75%) and partially concordant in 1 (6.25%). For the LTL, the results were concordant for all imaging modalities in 12 patients (75%), partially concordant in 3 (18.75%), and discordant in 1 (6.25%). For the TFC disk, the results were concordant for all imaging modalities in 13 patients (81.25%), partially concordant in 2 (12.5%), and discordant in 1 (6.25%). The arthroscopic and imaging findings were concordant for 3 SLLs, 3 LTLs, and 3 TFC disks. CONCLUSIONS Our preliminary results are encouraging. Sonography may be used at least as a screening imaging modality in evaluation of the SLL and TFC disk. Sonoarthrography improves evaluation of the LTL.
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Affiliation(s)
- Mihra S Taljanovic
- Department of Radiology, University of Arizona Health Sciences Center, Tucson 85724, USA.
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Kijowski R, De Smet AA. The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity. Clin Sports Med 2006; 25:569-90, viii. [PMID: 16798143 DOI: 10.1016/j.csm.2006.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The two major imaging modalities used for assessment of soft tissue injuries are ultrasound and MRI. Although ultrasound of the extremities is used only to a limited extent in the United States, it is widely used in many other countries for evaluation of extremity injuries. This article first considers the advantages and disadvantages of MRI and ultrasound. Understanding these differences will help the reader understand the role of ultrasound as compared with MRI in evaluating upper extremity injuries. The uses of ultrasound for evaluating sports medicine injuries in specific regions of the upper extremity are then reviewed. Where the data are available, the reported accuracy of ultrasound is compared with MRI for each type of injury.
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Affiliation(s)
- Richard Kijowski
- Division of Musculoskeletal Radiology, Department of Radiology, University of Wisconsin Clinical Science Center, 600 Highland Avenue, E3/311 CSC, Madison, WI 53792-3252, USA.
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Schmitt R, Froehner S, Coblenz G, Christopoulos G. Carpal instability. Eur Radiol 2006; 16:2161-78. [PMID: 16508768 DOI: 10.1007/s00330-006-0161-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 12/29/2005] [Accepted: 01/13/2006] [Indexed: 10/25/2022]
Abstract
This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads ("dyskinetics") or suffers from abnormal motion of its bones during movement ("dyskinematics"). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being "occult" for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the hand surgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.
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Affiliation(s)
- R Schmitt
- Herz- und Gefässklinik GmbH, Institut für Diagnostische und Interventionelle Radiologie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany.
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Kendi ATK, Güdemez E. Sonographic evaluation of scapholunate ligament: value of tissue harmonic imaging. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:109-12. [PMID: 16547997 DOI: 10.1002/jcu.20208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The aim of this study was to compare tissue harmonic imaging (THI) and conventional (fundamental) sonography in the evaluation of the scapholunate ligament (SLL). METHODS The bilateral SLL of 3 patients with unilateral SLL rupture and the bilateral SLL of 20 volunteers without history of trauma were examined. THI findings were compared with conventional sonographic findings. RESULTS On conventional sonographic evaluation of 43 normal wrists, the dorsal component of the SLL was partially visible in 10 of the 43 normal wrists (23%) and was completely visible in 33 of 43 (77%) normal wrists. Using THI, the SLL was visible in its entirety in 39 of 43 normal wrists (91%) and was partially visible in 4 of 43 normal wrists (9%). The mean scapholunate distance was 3.3 mm (range, 2.9-4.5 mm) in normal wrists. THI improved visualization of SLL continuity and demonstration of its fibrillar echotexture. In the 3 wrists with clinical and/or radiological evidence of SLL rupture, the SLL was not visible with conventional sonography nor THI; the mean scapholunate distance was 6.1 mm (range, 5.6-6.8 mm). CONCLUSIONS THI improves visualization of the SLL.
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Abstract
The advent of ultra-high-frequency sonographic transducers has significantly enhanced our ability to image superficial structures. As a result, sonography now can be used to assess injuries of the tendons in the wrist and hand. A clear understanding of normal sonographic anatomy is required to prevent misdiagnosis and ensure optimal patient care. The anatomy of the wrist and hand is best described by considering the extensor and flexor surfaces separately. The carpal extensor retinaculum divides the dorsal extensor tendons into six separate synovial compartments, which are demarcated by the points of its attachment to the radius and ulna. The course of these tendons from the wrist to the sites of their insertion can be traced by using sonography. The intrinsic wrist ligaments, triangular fibrocartilage, and dorsal finger extensor hood also can be assessed sonographically. The anatomy of the flexor surface of the wrist is defined principally by the flexor retinaculum. The median nerve, which is located deep to the retinaculum in the carpal tunnel, and the ulnar nerve, which is superficial to the retinaculum in the Guyon canal, can be easily detected. The long flexor tendons in the wrist and hand are also clearly depicted at sonography. The flexor annular pulley system is formed by five foci of thickening along the long flexor finger tendon synovial sheath, and the second and fourth annular pulleys can be identified sonographically in most patients. Sonography provides a rapid, cheap, noninvasive, and dynamic method for examination of the soft-tissue structures of the wrist and hand. Familiarity with the appearance of normal anatomic structures is a prerequisite for reliable interpretation of the resultant sonograms.
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Affiliation(s)
- Justin C Lee
- Department of Radiology, Chelsea and Westminster Hospital, London SW10 9NH, England.
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Boutry N, Lapegue F, Masi L, Claret A, Demondion X, Cotten A. Ultrasonographic evaluation of normal extrinsic and intrinsic carpal ligaments: preliminary experience. Skeletal Radiol 2005; 34:513-21. [PMID: 16010593 DOI: 10.1007/s00256-005-0929-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 02/23/2005] [Accepted: 04/08/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine normal anatomy of extrinsic and intrinsic carpal ligaments at ultrasonography (US). DESIGN AND VOLUNTEERS In the first part of the study, two musculoskeletal radiologists retrospectively reviewed in consensus the photographs of anatomic sections and dissections derived from 20 cadaveric wrists. This cadaveric study gave the two readers the opportunity to learn the anatomy and orientation of the various extrinsic and intrinsic carpal ligaments and, thus, to develop a US protocol to facilitate the recognition of each carpal ligament. In the second part of the study, these two radiologists prospectively and independently evaluated the visibility of extrinsic and intrinsic carpal ligaments in 30 wrists of volunteers, using the same US protocol. RESULTS With regard to extrinsic carpal ligaments, the radioscaphocapitate ligament (partially visible, 38%; completely visible, 62%), the radiolunotriquetral ligament (partially visible, 27%; completely visible, 73%), the palmar ulnotriquetral ligament (partially visible, 12%; completely visible, 88%), and the dorsal radiotriquetral ligament (partially visible, 7%; completely visible, 93%) were visualized at US. The dorsal ulnotriquetral ligament (partially visible, 21%; completely visible, 74%), the ulnolunate ligament (partially visible, 5%; completely visible, 70%), and the radial collateral ligament (partially visible, 18%; completely visible, 12%) were more difficult to recognize. The radioscapholunate ligament was never seen. With regard to intrinsic carpal ligaments, the dorsal (partially visible, 11%; completely visible, 89%) and palmar (partially visible, 38%; completely visible, 62%) scaphotriquetral ligaments as well as the dorsal scapholunate ligament (partially visible, 3%; completely visible, 97%) were visualized at US. The dorsal lunotriquetral ligament (partially visible, 39%; completely visible, 61%) and the palmar scapholunate ligaments (partially visible, 12%; completely visible, 81%) were more difficult to recognize. CONCLUSION US may be helpful in identifying the major extrinsic and intrinsic carpal ligaments.
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Affiliation(s)
- Nathalie Boutry
- Musculoskeletal Radiology Department, Hôpital Roger Salengro, CHRU de Lille, Boulevard du Pr. J Leclercq, 59037, Lille Cedex, France.
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Mohr A, Guermazi A, Genant HK. Value of sonography of the scapholunate ligament. AJR Am J Roentgenol 2003; 181:275-7; author reply 277. [PMID: 12818873 DOI: 10.2214/ajr.181.1.1810275b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jacobson JA, Propeck T, Jamadar DA, Jebson PJL, Hayes CW. US of the anterior bundle of the ulnar collateral ligament: findings in five cadaver elbows with MR arthrographic and anatomic comparison--initial observations. Radiology 2003; 227:561-6. [PMID: 12732704 DOI: 10.1148/radiol.2272020462] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To characterize the ultrasonographic (US) appearance of the anterior bundle of the ulnar collateral ligament of the elbow by comparing US images with magnetic resonance (MR) arthrograms and anatomic slices. MATERIALS AND METHODS The ulnar collateral ligament in four cadavers (eight elbows) was blindly evaluated with US by one musculoskeletal radiologist with experience in musculoskeletal US. These results were compared with standard arthrograms, MR arthrograms, and anatomic slices by consensus reading of two musculoskeletal radiologists. The criteria for an abnormal ulnar collateral ligament included contrast material extension into the ligament or fiber discontinuity, as documented by MR arthrography and anatomic slices. RESULTS Standard arthrography, MR arthrography, and anatomic slices demonstrated the ulnar collateral ligament to be unequivocally normal in three specimens and abnormal in two. The remaining three elbows did not meet the criteria for classification as either normal or abnormal, and thus they were excluded from the study. With US, the normal ulnar collateral ligament was fibrillar and hyperechoic between the medial epicondyle and proximal ulna. In the two abnormal cases, abnormal hypoechogenicity and ligament fiber disruption were noted. In addition, the proximal aspect of the ulnar collateral ligament varied from a cordlike structure to a broad attachment to the undersurface of the medial epicondyle with variable fat. CONCLUSION In this small sample, the anterior bundle of the ulnar collateral ligament is identified with US by its hyperechoic and compact fibrillar echotexture. The proximal attachment of the ulnar collateral ligament has a variable appearance. Hypoechogenicity and fiber disruption indicated ulnar collateral ligament abnormality.
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Affiliation(s)
- Jon A Jacobson
- Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910G, Ann Arbor 48109-0326, USA.
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Torriani M, Kattapuram SV. Musculoskeletal ultrasound: an alternative imaging modality for sports-related injuries. Top Magn Reson Imaging 2003; 14:103-11. [PMID: 12606872 DOI: 10.1097/00002142-200302000-00008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Advanced technology and increasing clinical experience have established sonography as a reliable imaging modality for sports-related injuries. Tears of muscles and tendons, tendinosis, and tenosynovitis are promptly diagnosed using ultrasound. Dynamic assessment of joints can be performed, allowing diagnoses of conditions that may remain undetected when evaluated with conventional magnetic resonance imaging. Sonography provides expeditious image guidance for procedures such as drainage of fluid collections and cysts. This article reviews the applications of sonography to sports-related injuries in which its diagnostic performance may be comparable to magnetic resonance imaging.
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Affiliation(s)
- Martin Torriani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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