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PubMed1994

Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain.

To determine the significance of arthrographic abnormalities in patients with unilateral wrist pain, the authors compared the prevalence and site of intra-articular ligament perforation in asymptomatic and symptomatic wrists of the same group of patients and correlated asymptomatic perforation with age, hand dominance and hand overuse. Thirty-seven patients (29 men and 8 women ranging in age from 19 to 61 years) who had unilateral wrist pain and positive arthrographic findings for the symptomatic wrist underwent radiocarpal arthrography of the asymptomatic wrist. Three radiologists blinded as to the clinical findings examined the images for perforation in the triangular fibrocartilage complex, the lunotriquetral ligament and the scapholunate ligament. Intra-articular ligament perforations were found in 33 (89%) of the 37 asymptomatic wrists. Seventeen (46%) of the 37 patients had symmetric sites of perforation in the two wrists. Perforation of the triangular fibrocartilage complex occurred in 22 (59%) and 19 (51%) of the symptomatic and asymptomatic wrists respectively, of the lunotriquetral ligament in 13 (35%) and 7 (19%) respectively and of the scapholunate ligament in 13 (35%) and 11 (30%) respectively. No significant correlation between asymptomatic perforation and age or hand overuse was found (chi 2 test, Fisher's exact test). The authors conclude that asymptomatic perforation is common, even in young patients, so ligament perforation is not necessarily the cause of wrist pain in patients with such pain. However, for patients with the appropriate clinical findings, arthrography can be used to confirm or exclude ligament perforation.

Adult↗

PubMed1993

Arthrography of the temporomandibular joint: pictorial essay.

Although arthrography of the TMJ is nowadays considered as old-fashioned, the technique remains a valuable alternative in cases where MRI is contraindicated. The authors discuss the technique of inferior joint space arthrography and present a review of typical arthrographic cases of the most common types of TMJ pathology.

Arthrography↗

PubMed1993

[Arthro-scanner of the knee: current indication, examination of the femoro-tibial compartment. Comparative study with classical simple-contrast media arthrography].

The authors report on a series of 50 single contrast knee arthroscans and describe a method of examination in fine sections that allows for a detailed analysis of the femoro-tibial compartment. The authors compared the sensitivity of the single contrast arthrography with their arthroscanner technique. Thus they prove the major interest of the fine section arthroscanner in assessing chondropathies of all types, the frequency and stage of which are heavily underestimated in conventional arthrography, not only in respect of the patella but also where the other covering cartilages are concerned. They also demonstrate the additional interest of the arthroscanner for certain meniscus and ligament lesions as well as for detecting osteochondromatosis nodules.

Adolescent↗

PubMed1993

[A combination of conventional single contrast arthrography with arthro-CT of the shoulder--an evaluation of 78 cases].

For the diagnosis of traumatic shoulder lesions, 78 patients have been examined by conventional single contrast arthrography with subsequent CT. For 26 patients, it was possible to compare the radiological diagnosis with the arthroscopic or surgical findings. The combination of both diagnostic methods provided a high sensitivity (94%) and specificity (100%) for lesions of the ventral or dorsal limbus. Ruptures of the rotator cuff showed a sensitivity of 60% and a specificity of 89%. An unsatisfying sensitivity (60%) with high specificity (95.6%) was observed in the diagnosis of the ventral capsula. A retrospective screening of the roentgenography showed a good detectable leak of contrast medium, which was misinterpreted as being an artefact. All in all, the combination of conventional arthrography in mono-contrast and CT in daily routine should be recommended the diagnosis of traumatic shoulder lesions since it is easy to use, is of low inconvenience for the patient, and provides a high level of information.

Adolescent↗

PubMed1993

Role of arthrography in non-traumatic painful wrist.

The arthrographic examination was carried out in 25 patients with non-traumatic painful wrist of more than 6 weeks duration. Plain x-rays were non-contributory in making any diagnosis in 20 cases. Arthrography was performed even when plain x-rays were normal and it revealed the soft tissue abnormalities and early phases of cartilage destruction not visible on routine roentgenograms. The extent of synovial involvement demonstrated on arthrography proved useful when synovectomy was planned. After operation pain and swelling disappeared and functions of the joint improved considerably.

Arthritis, Rheumatoid↗

PubMed1993

Wrist arthrography.

The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congenital perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC.

Arthrography↗

PubMed1995

[Results of sutures of the internal meniscus associated with reconstruction of the anterior cruciate ligament in chronic knee joint instability. Apropos of 42 cases, 30 of them controlled by arthrography].

PURPOSE OF THE STUDY: Most authors agree on the importance of medial meniscus preservation in the case of A.C.L. reconstructive surgery. The purpose of this study was to analyze the anatomical results of sutures of medial meniscus tears by the means of arthrography. MATERIAL: Medial meniscus 42 sutures for peripheral tears at the posterior horn (length between 10 and 50 mm, 70 per cent greater than 20 mm) had been performed through an open procedure using a posterior approach. The average age of the patients was 24 years (17-54) with a clear male predominance (64 per cent). The average age at the time of injury was 22 years, 6 months. METHODS: The patients were operated on by the same surgeon, with the same technique. Resorbable sutures were used spaced every-3 mm, and tightened outside the joint. The A.C.L. was reconstructed by a bone-patellar tendon-bone technique (modified K.G. Jones). A first series of 13-patients were no weight bearing allowed for 6 weeks post-operatively. A second series of 29 patients were allowed immediate partial weight bearing. All the patients were permitted active flexion. All the patients had been examined with a minimum of 6 months follow-up. They were all controlled clinically (results evaluated with the I.K.D.C. score) and with passive dynamic X rays to measure residual laxity. 32 patients had an arthrogram before the operation in the aim to compare with the postoperative arthrogram. 30 patients had an arthrogram after an average of 21 months. 12 patients refused follow-up arthrograms. 9 patients had arthroscopy for pain or effusion. RESULTS: All the patients obtained a range of flexion-between 90 degrees and 110 degrees at 4 weeks. A flexed contracture of 10 degrees was noted in only 1 case. Meniscal functional results were good for 32 cases after a mean follow-up of 4 years and 4 months. Arthrograms in 30 cases showed no residual tear in 19 cases (63 per cent), 3 cases had incomplete healing and 8 cases had failed. The healing was influenced by the size of the tear, its situation near the posterior wall. In the first series (no weight bearing), there were 2 failures for 9 cases and 6 out of 21 in the second series and 3 incomplete healing. There was no correlation between meniscal functional results and functional ligamentous results evaluated with the I.K.D.C. score. 9 patients had an arthroscopy and 7 out of them a meniscectomy (after 17 months 3). CONCLUSIONS: This study confirms the possibility of healing following suture of peripheral medial meniscal tears in the case of ACL reconstructive surgery (even if the tear is long). The use of arthrogram, before the operation and for anatomical control after the operation, ensures complete healing (better than M.R.I. for the suture control). Arthrography is certainly a less invasive technique than arthroscopy.

Adolescent↗

PubMed1997

[Chronic external instability of the ankle. Contribution of dynamic radiographies, x-ray computed tomography and x-ray computed tomographic arthrography].

We retrospectively evaluated the anterior talo fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, in particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous).

Adolescent↗

PubMed1998

Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy.

OBJECTIVE: To evaluate the short- and long-term efficacy of joint distention during arthrography followed by an intraarticular corticosteroid injection then by high-intensity physical therapy and use of an abduction splint in an open study of 40 patients with adhesive capsulitis of the shoulder. METHODS: Patients were evaluated on D0, D5 (i.e., before discharge) and D30 for pain severity assessed using a four-point scale (0-3) and for passive ranges of abduction, internal rotation and external rotation of the shoulder. RESULTS: Mean pain severity improved significantly from 2.18 +/- 0.6 (mean +/- SD) on D0 to 1.74 +/- 0.5 on D5 (P: 0.01) and 0.92 +/- 0.5 on D30 (P: 0.02). Passive range of abduction increased significantly from 44.8 degrees +/- 1.54 degrees on D0 to 68 degrees +/- 15 degrees on D5 (P: 0.05), whereas the difference between D5 and D30 (71 degrees +/- 13 degrees) was not significant (P: 0.8). Similarly, passive range of external rotation increased significantly from 4.3 degrees +/- 0.6 degree on D0 to 13.5 degrees +/- 0.5 degree on D5 (P = 0.04) and showed a nonsignificant increase from D5 to D30 (17 degrees +/- 13 degrees, P: 0.2). CONCLUSION: Joint distention during arthrography followed by an intraarticular corticosteroid injection then by high-intensity physical therapy significantly improved pain and passive range of motion within the first five days, and these gains were sustained after one month.

Adrenal Cortex Hormones↗

PubMed1997

-Arthrography of the hip prosthesis-.

Arthrography of hip arthroplasties is a safe, easy-to-perform procedure. It is mainly indicated when infection of the arthroplasty is suspected: the contrast agent fills bone defects that may be present between normal bone and the prosthesis and reaspiration of injected fluids may lead to bacteriological diagnosis. Another indication for arthrography of hip arthroplasties is unexplained painful hip prosthesis.

Arthrography↗

PubMedDate not supplied

Distribution of normal and abnormal fluid collections in the glenohumeral joint: implications for MR arthrography.

Although magnetic resonance (MR) images of the glenohumeral joint frequently demonstrate intraarticular fluid, no specific criteria have, to the authors' knowledge, been published that allow accurate assessment of the amount of fluid present. Also, despite the increasing use of MR arthrography of the shoulder, the optimal amount of intraarticular fluid that should be used with this technique has not been determined. The authors progressively distended the glenohumeral joint in six cadaveric shoulder specimens with a dilute gadopentetate dimeglumine solution and obtained MR images after injection of 2, 5, 10, 15, and 20 mL of the solution. The pattern of fluid distribution was evaluated, and these results were then used to estimate the amount of fluid that was present in the glenohumeral joint on MR images of 20 shoulders obtained in 12 asymptomatic volunteers. In 14 of these shoulders, intraarticular fluid was present; however, in none was more than 2 mL evident. Results of the cadaveric study also indicated that 15 mL of intraarticular fluid appears to be the optimal amount for MR arthrography.

Adult↗

PubMed2005

Optimization of indirect arthrography of the knee by application of external heat: initial experience.

PURPOSE: To examine the potential utility of applying heat to increase the uptake of intravenous gadolinium (Gd) contrast into the knee joint in order to optimize MR arthrography. MATERIALS AND METHODS: At 1.5T, 16 knees in eight patients without prior surgery, injury, or pain were examined before and 30 minutes after intravenous administration of Gd contrast (0.1 mM/kg). Between scans a heating pad was applied to the anterior aspect of eight randomly selected knees (the contralateral knee served as the control). Initial and postcontrast imaging consisted of identical axial T1-weighted sequences (TR/TE = 500/14 msec) without fat suppression. On the initial and postcontrast images, regions of interest (ROIs) were placed at identical locations in the suprapatellar pouch and the intercondylar notch by a reader blinded to the treated side. The values at these two locations were averaged and the change in joint signal intensity was calculated. The differences between the heated and unheated knees were also calculated. RESULTS: Seven of the eight knees treated with heat had increased joint enhancement compared to the contralateral control, with percentage changes in joint signal intensity (heated knee vs. control) of +38%, +80%, +121%, +145%, +150%, +164%, and +177%. Overall there was a doubling of signal intensity (125%) on the heated side compared to the contralateral control (with significance at P = 0.039). One patient was excluded because of a prior knee injury. CONCLUSION: The application of external heat increases uptake of intravenously administered Gd contrast into the knee joint, and may help to optimize indirect MR arthrography at a relatively low cost.

Adult↗

PubMed1995

Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management.

Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral posttraumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18-55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown.

Adolescent↗

PubMed1995

Bupivicaine arthrography of the post-arthroplasty hip.

Addition of bupivicaine, a medium-length-acting local anesthetic, to the contrast material in arthrography of total hip prostheses provides reliable information as to whether the source of pain is intracapsular or extracapsular. In 12 surgically proven cases, complete relief of pain after bupivicaine injection correctly identified an intracapsular source of pain in 10, with only 1 false-positive and 1 false-negative. These results compare favorably with the results of the contrast arthrograms in these patients in localizing the pain even if a specific diagnosis could not be reached. Bupivicaine as an adjunct to contrast material during arthrography provides additional information useful in management decisions regarding the necessity of revision arthroplasty.

Anesthetics, Local↗

PubMed1984

Clinical diagnosis, arthrography, stress examination and surgical findings after inversion trauma of the ankle.

In a series of 921 patients with acute inversion trauma of the ankle joint, the diagnostic features of lateral ligamentous ruptures were evaluated. Patients with proven lateral ligamentous rupture (150 patients in this series) were submitted to a prospective trial to compare three methods of treatment. In the 50 patients operated upon, the results of clinical diagnosis, stress radiography, and ankle arthrography were compared with surgical findings. Clinical diagnosis proved to be of very little value. The positive signs of ankle arthrography showed a reliability of 96% in predicting ligamentous rupture. Inversion stress radiography under full anesthesia showed a reliability of 92%, but the same investigation under local anesthesia, however, was only 68%.

Ankle Injuries↗

PubMed1982

Performing shoulder arthrography without image converters in the field of orthopedic accident surgery.

This paper describes a method by which a shoulder arthrography may be carried out without the aid of fluoroscopy. To provide all patients with the best therapy possible, one should be able to perform arthrographies without having to own an image intensifier. The process of mixing a radiopaque substance with a local anesthetic agent combined with air will in itself dissolve existing adhesions during the tapping of the joint, as a result of which this diagnostic procedure will turn into therapy. In cases of extensive lacerations of the joint capsule, it is not possible to obtain a clear outline of the intra-articular structures, but on the other hand we shall frequently meet with a diffuse outflow of the mixture into the surrounding musculature. No allergic reactions to the radiopaque substance were observed.

Adolescent↗

PubMed2006

Comparison of the MR findings on indirect MR arthrography in patients with rotator cuff tears with and without symptoms.

PURPOSE: To compare indirect magnetic resonance (MR) arthrography findings in patients with rotator cuff tears with and without symptoms. MATERIALS AND METHODS: Indirect MR arthrography results of 15 asymptomatic and 23 symptomatic rotator cuff tears were retrospectively reviewed, comparing the type and size of tears and amount of subacrominal-subdeltoid bursal fluid. RESULTS: There were 14 partial-thickness tears and one full-thickness tear in the asymptomatic group, with 4 small and 11 medium tears. In the symptomatic group, there were 16 partial-thickness and 7 full-thickness tears, with 14 small, 5 medium, and 4 large tears. In the asymptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 6 patients; grade 1, 6 patients; grade 2, 2 patients; and grade 3, 1 patient. In the symptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 4 patients; grade 1, 3 patients; grade 2, 8 patients; and grade 3, 8 patients. We found no statistically significant difference between symptomatic and asymptomatic tears in the kind and size of tears, and in the amount of subacrominal-subdeltoid bursal fluid. CONCLUSION: We found no difference in the MR findings between symptomatic and asymptomatic rotator cuff tears.

Aged↗

PubMed1996

[MRI-guided MRI arthrography of the shoulder].

PURPOSE: To develop an MR-guided technique for joint puncture in MR arthrography of the shoulder and to confirm the intracapsular position of the needle tip by visualization of the flow of contrast media into the joint. MATERIALS AND METHODS: Three unfixed human shoulder joint specimens were examined on a LOT unit. The optimal point of entrance and depth for joint puncture were estimated by means of MR-compatible markers on the skin. Needle orientation and localization of the needle tip (MR-compatible 22-gauge needle) in the shoulder joint were monitored by rapid localizer gradient-echo sequences in two or thogonal planes. To confirm the intracapsular position of the needle tip, diluted gadolinium-DTPA was administered via a long connecting tube and the flow of contrast media into the joint was viewed directly on an LCD screen using real-time MR imaging (local look technique). RESULTS: The MR-compatible markers on the skin allowed determination of the optimal point of entrance and estimation of the depth for joint puncture. Passive visualization of the MR-compatible needle due to spin dephasing and signal loss provided adequate localization of the intra-articular needle tip position in all specimens, although significant artefacts were present on rapid localizer gradient-echo sequences with an increase in width of the apparent needle shaft. Real-time MR imaging of the flow of contrast media was possible using the local look technique and the LCD screen of the MR unit and allowed confirmation of the intracapsular position. CONCLUSION: MR-guided joint puncture and real-time MR-assisted contrast media application results in improved MR-arthrography and may replace conventional fluoroscopic guidance.

Contrast Media↗