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PubMed1991

Arthrography of the hand and wrist.

Arthrography of the wrist and hand is easy to perform, but accurate diagnosis requires meticulous technique and thorough knowledge of anatomy, pathology, and imaging principles. Wrist arthrography is usually performed to assess pain or instability after trauma; a complete examination usually requires injection of the RC, midcarpal, and distal radioulnar joints. Abnormalities that can be detected include interosseous ligament tears, capsular tears, triangular fibrocartilage perforations and separations, cartilaginous defects, loose bodies, and synovial abnormalities including adhesive capsulitis. Arthrography can also be useful in the evaluation of masses and scaphoid nonunion. Finger arthrography can demonstrate capsular injury, ligament tears, tendon derangement, volar plate disruption, cartilage abnormalities, fibrous ankylosis, synovial abnormalities, and ganglia. Tenography is seldom performed; this technique can delineate synovial abnormalities and can be used to evaluate tendon subluxation.

Arthrography↗
PubMed1990

Imaging of the wrist.

A wide variety of radiologic tools now exists for the assessment of the bones and soft tissues of the wrist. The selection of the most appropriate modality requires that the radiologist be conversant both with this armamentarium and with the needs of the referring clinician requesting diagnostic help. Although most static abnormalities may be nicely displayed on routine plain films and special projections, many dynamic abnormalities require motion or stress views to demonstrate their presence. The three-phase radionuclide bone scan allows the radiologist to judge the acute or chronic nature of the abnormality being assessed. Subluxations involving the distal radioulnar joint are relatively easily recognized with CT scanning through that joint. These abnormalities are seen infrequently and are unreliably diagnosed from the plain film examination alone. Although the triple injection arthrogram seems to be a sensitive and accurate tool for identifying ligamentous perforations including those of the triangular fibrocartilage, the potential for those diagnoses to be made with MR imaging is increasingly recognized.

Diagnostic Imaging↗
PubMed1989

CT of the wrist for the evaluation of traumatic injuries.

Computed tomography (CT) of the wrist can help evaluate many types of posttraumatic injuries, particularly bony trauma. Most wrist fractures can be diagnosed with routine radiography, but problematic cases and complicated healing fractures can be difficult to evaluate with conventional radiography. CT provides improved contrast resolution and multiplanar imaging. The results of complex healing fractures and fusion procedures can be facilitated with CT. Even in the face of advanced osteoporosis CT can delineate bone edges and detect small areas of bony fusion. The degree of bone graft assimilation can be determined with CT. Unlike conventional radiography, metal fixation pins and cast material do not obviate diagnostic exams with CT. Certain posttraumatic complications such as distal radioulnar joint incongruity and hypertrophy of Lister's tubercle can be detected with axial CT images. Complicated cases of retained foreign bodies can be evaluated with CT. The high-contrast resolution of CT allows precise localization of foreign bodies and can define anatomic relationships to adjacent vital structures such as joints, tendons, and carpal tunnel. Postarthrography CT of the wrist is an investigational tool that permits direct visualization of the triangular fibrocartilage complex (TFCC). Complete and partial tears of the TFCC can be evaluated with postarthrography CT. Ulnar capsular tears and disruptions of interosseous ligaments can also be evaluated with this technique. The exact role of postarthrography CT of the wrist, however, is uncertain at this point. Three-dimensional CT is receiving increasing interest and may eventually help the understanding of wrist pathomechanics and kinematics. In summary, CT of the wrist can be instrumental in evaluating complicated posttraumatic injuries of the wrist and has certain advantages over routine radiography.

Humans↗
PubMed1989

[Possibilities of MR tomography of diseases of the hand and wrist].

MRI studies of 63 patients with various abnormalities of the hand and wrist were analyzed. Studies were performed on scanners with a field strength of 0.35, 0.5, or 1.5 T. Imaging parameters included T1- and T2-weighted sequences in the coronal and transverse planes and contiguous slices 3-5 mm thick. In 37 patients with post-traumatic disorders, MRI revealed carpal avascular necrosis, tendon abnormalities and, in some cases, abnormalities of interosseous ligaments and the triangular fibrocartilage. In 15 patients with such inflammatory diseases as arthritis, tenosynovitis and carpal tunnel syndrome and in 11 patients with tumors, MRI provided clear delineation of osseous and soft tissue abnormalities. The current role of MRI in the diagnosis of hand and wrist abnormalities is discussed on the basis of these results.

Adolescent↗
PubMed1988

Irreducible fracture-dislocation of the distal radioulnar joint secondary to entrapment of the extensor carpi ulnaris tendon.

Entrapment of the extensor carpi ulnaris (ECU) tendon between the ulnar head and the sigmoid notch of the radius occurred in a 12-year-old boy. This led to an irreducible dorsal dislocation of the distal radioulnar joint (DRUJ). Irreducible DRUJ dislocations are uncommon, and the entrapped ECU has not been previously described in a skeletally immature patient. The physical and roentgenographic findings of a dorsally displaced ulna, a widened DRUJ, and the inability to obtain a closed reduction should alert the examiner to the need for exploration. A dorsal exposure is required to free the ECU and reconstruct the triangular fibrocartilage complex.

Child↗
PubMed1987

Ulnar lengthening and shortening.

Alteration in length of the distal ulna may provide an attractive alternative to more destructive procedures commonly used for the treatment of mechanical and degenerative problems at the distal radioulnar joint. Ulnar recession has shown effectiveness in ulnolunate impingement, triangular fibrocartilage tears, and symptomatic ulnar plus variance. It has also been effective in chondromalacia of the ulnar head in the sigmoid notch and in unstable distal radioulnar joints where recession alters the bearing surface and tightens the ulnocarpal ligamentous complex. Ulnar lengthening has been efficacious in relieving the symptoms of Kienböck's disease by decompressing the involved portion of the lunate and distributing joint compressive force on the triquetrum and medial lunate articular surfaces. It may also be of value in some instances of NDCI associated with an ulnar minus variant.

Bone Lengthening↗
PubMed1978

[Ligamentous injuries of the wrist joint (author's transl)].

Author deal with some basic type of ligamentous injuries around the wrist. Attention is drown to the significance of injuries to the distal radio-ulnar ligamentsystem, the triangular fibrocartilage, and ulnar carpal ligament. Diagnostic and therapeutic methods are recommended. The importance for treatment of ligamentous injuries around the wrist joint is emphasized.

Humans↗
PubMed1985

Athletic injuries of the wrist.

The wrist is at risk for injury in many athletic endeavors, often in acute falls or dorsiflexion injuries and at other times from repetitive stress involved with fitness routines or specific motions called for in the sport. Dorsiflexion accounts for most wrist problems giving rise to compression injuries dorsally such as scaphoid impaction, triquetrohamate impaction, and occult ganglions. These are seen most often in weight lifters, gymnasts, and push-up enthusiasts. Tension injuries occur on the palmar aspect of the wrist with disruption or attenuation of the supporting ligaments or interosseous membranes. This provides scapholunate tears, scapholunate dissociation, lunatotriquetral, midcarpal instability problems, and so forth, which are generally the result of single energetic injuries commonly associated with contact sports. Distal radioulnar injuries include chondromalacia of the ulnar head, ulnar head subluxation, and ulnocarpal impingements with tears of the triangular fibrocartilage. Forceful rotational injuries are generally associated with the former and stressful ulnar deviation with the latter, where tennis players and baseball batters are at risk. Fracture of the hook of the hamate and pisotriquetral chondromalacia are common in sports requiring holding a club, handle, or bat. Precise, early diagnosis affords the best chance for successful treatment.

Adult↗
PubMedDate not supplied

Biomechanics of the distal radioulnar joint.

The distal radioulnar joint is an intricate part of wrist function. The radius and hand move in relation to, and function about, the distal ulna. Significant loads are transmitted to the forearm unit through the distal ulna via the triangular fibrocartilage. The anatomic relations between the distal radius and ulna and the ulnar carpus are precise, and even minor modifications in these relations leads to significant load-pattern changes. The authors can only speculate on the clinical ramifications of such load-pattern modifications. Since M. DeSault's dissertation on dislocation of the distal radius, published in 1791, much has been written on injuries to, and afflictions of, the radiocarpal area. Although injuries and afflictions in this area undoubtedly have not changed throughout the years, an increasing variety of ulnar wrist syndromes and treatment programs are being recognized. This phenomenon attests not only to the need for continuous investigations of wrist problems but also to the great excitement that presently exists in the field. Better understanding of the anatomy and newer knowledge of the biomechanics of the distal radioulnar joint should herald an ulnar wrist renaissance.

Biomechanical Phenomena↗
PubMedDate not supplied

Wrist arthrography.

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

Arthritis, Rheumatoid↗
PubMed1995

MR imaging of normal and injured wrist ligaments.

MR imaging is a rapidly evolving modality for examining the ligaments of the wrist. Recent improvements in magnet design and receiver coil technology have allowed consistent visualization of the wrist ligaments. Image quality can be optimized by selection of the proper receiver coil, careful attention to patient comfort and positioning, and selection of a dedicated imaging protocol. The carpal ligaments can be classified as capsular or interosseous ligaments, with the most important interosseous ligaments being the SLL and LTL as well as the triangular fibrocartilage. It is important for radiologists to understand the anatomy of the carpal ligaments in addition to the normal range of MR appearances as basis for comparison with torn or degenerated carpal ligaments.

Humans↗
PubMed1995

[Load transmission through the wrist joint: a biomechanical study comparing the normal and pathological wrist].

This study was undertaken to elucidate the correlation, if any, between pressure loading and the progress of degenerative osteoarthritis in the human wrist. Nine fresh amputated forearms were used to produce i) a pathological model of a malunion after a distal radius fracture, ii) a model of a triangular fibrocartilage (TFC) tear, and iii) a model of a scapholunate dissociated wrist (involving three specimens for each model). On pressure loading, changes in the radioulno-carpal joint and in the midcarpal joint were measured using a pressure sensor. In the malunion of the distal radial end, we found that a pressure fluctuation occurred at more than a 20 degrees dorsal tilt with greater than ulnar +2 mm variance. The loads on the TFC surface and on the scaphoid surface increased, causing the pressure loading site to move dorsally. In the model of a partial TFC resection, sufficient decompression was achieved at the resection site for ulnar 0 mm variance. However, at +2.5 mm variance, the pressure loading caused a concentrated pressure to occur on the TFC surface and the decompression became ineffective. So for a +2.5 mm variance in this model, shortening the ulnar diaphysis is suggested as adequate for a clinical reduction in pressure. In the scapholunate dissociated model, we observed decreased pressure in the radioscaphoid articulation and scaphocapitate articulation, during volar rotation of the scaphoid, while there was increased pressure in the radiolunate and in the lunocapitate articulation. In all models, the focus of the increased pressure was correlated with radiographic findings as being the same as the site of morphological degeneration, suggesting a close correlation between abnormal pressure and the progression of degenerative osteoarthritis.

Biomechanical Phenomena↗
PubMed1995

Arthroscopy for carpal instability.

Arthroscopy of the wrist has become a valuable adjunct in the evaluation and treatment of injuries to the wrist. Arthroscopic visualization aids in the diagnosis and management of carpal instability, triangular fibrocartilage complex tears, and certain fractures. Arthroscopically assisted stabilization and reconstruction allow rapid rehabilitation and functional recovery.

Arthroscopy↗
PubMed1995

Malunions of the distal radius: treatment options.

Approaches to malunion of the distal radius may be viewed as a hierarchy of surgical options with increasing complexity and potential surgical morbidity. Choice of an appropriate surgical approach requires consideration of the patient's activity level, as well as the anatomic distortion that is present. In the posttraumatic situation, there is lack of agreement as to management of the distal ulna. Relative increased ulnar length and triangular fibrocartilage insufficiency make use of partial resection techniques more difficult. Osteotomy of the distal radius with or without a concomitant distal ulna procedure most nearly re-creates the preinjury situation anatomically and is seeing increasingly widespread application. It continues to be a challenging procedure from a technical standpoint. The need for procedures discussed in this review could be drastically reduced by a more aggressive approach to the initial fracture.

Arthrodesis↗
PubMed1994

Stabilization of the distal radioulnar joint after ulnar styloid nonunion using Mitek anchors.

Nonunion of the ulnar styloid is a relatively common injury that can often be ignored. In patients presenting with pain, compromised range of motion, and decreased grip strength, careful physical examination, and dynamic radiographic evaluation may document distal radioulnar joint instability. Mitek anchors provide a simple, effective means of triangular fibrocartilage complex reattachment, providing stabilization of the distal radioulnar joint.

Equipment Design↗
PubMed1994

The distal radioulnar joint following Galeazzi's fracture.

Fourteen patients underwent evaluation of the distal radioulnar joint following Galeazzi's fracture. Five of 12 patients who underwent a preoperative magnetic resonance imaging scan of the wrist had evidence of injury to the triangular fibrocartilage complex. These 5 patients also had abnormal intraoperative radiocarpal arthrograms. The amount of radial shortening in the injured forearm was measured prior to surgical treatment. Injury to the distal radioulnar joint appeared to be independent of the amount of radial shortening.

Adolescent↗
PubMed1994

[Magnetic resonance tomography of the hand: current status].

Magnetic resonance imaging (MRI) is an established imaging method in abnormalities of the wrist. Inherent advantages of this imaging method such as the lack of ionizing irradiation, the free choice of imaging planes and its excellent contrast resolution have been enhanced by the introduction of surface coils and new sequences. These developments result in an improved spatial resolution, allowing imaging of small structures such as the triangular fibrocartilage. There is a number of established indications for MRI of the wrist, e.g. diagnosis of avascular necrosis, follow-up after carpal tunnel surgery and imaging of soft tissue masses. Increasingly, MRI can be used for the diagnosis of intercarpal ligament tears as well. The diagnostic capabilities of MRI of the wrist are discussed, based on personal experience and a review of the literature.

Carpal Tunnel Syndrome↗
PubMed1994

[Diagnosis of the ulnocarpal complex in MRI cineradiography].

73 patients with persistent ulnar wrist pain of undetermined origin were examined by Magnetic Resonance Imaging (MRI). A series of 15 coronal slices was acquired using a T2* weighted gradient echo sequence. With repetitive measurement of those three slices that showed the triangular fibrocartilage complex (TFCC) best, the carpus was imaged 12 times during radial-ulnar deviation in increments of five degrees. The single images were combined according to their slice positions and continuously displayed on an image workstation, allowing for kinematic evaluation. Three different types of impingement of the TFCC were identified.

Adolescent↗