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      Ulnar-sided wrist pain. II. Clinical imaging and treatment

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          Abstract

          Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.

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          Triangular fibrocartilage complex lesions: a classification.

          Andrew Palmer (1989)
          Based on anatomic and biomechanical studies and review of our clinical experience of the past 10 years, a classification of injuries to the triangular fibrocartilage complex is presented. This classification is based on the clinical examination, routine x-ray films, wrist arthrograms, wrist arthroscopy, and wrist arthrotomy. The classification recognizes both traumatic and degenerative lesions. Traumatic lesions are classified according to their location. Degenerative lesions are classified by the location and severity of degenerative changes of the triangular fibrocartilage complex, ulnar head, ulnocarpal bones and lunotriquetral ligament.
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            Special focus session. MR arthrography.

            Lynne Steinbach, William E Palmer, Mark Schweitzer (2015)
            Direct magnetic resonance (MR) arthrography with injection of saline solution or diluted gadolinium can be useful for evaluating certain pathologic conditions in the joints. It is most helpful for outlining labral-ligamentous abnormalities in the shoulder and distinguishing partial-thickness from full-thickness tears in the rotator cuff, demonstrating labral tears in the hip, showing partial- and full-thickness tears of the collateral ligament of the elbow and delineating bands in the elbow, identifying residual or recurrent tears in the knee following meniscectomy, increasing the certainty of perforations of the ligaments and triangular fibrocartilage in the wrist, correctly identifying ligament tears in the ankle and increasing the sensitivity for ankle impingement syndromes, assessing the stability of osteochondral lesions in the articular surface of joints, and delineating loose bodies in joints. Indirect MR arthrography with intravenous administration of diluted gadolinium may be performed when direct arthrography is inconvenient or not logistically feasible. Although indirect MR arthrography has some disadvantages vis-à-vis direct MR arthrography, it does not require fluoroscopic guidance or joint injection and it is superior to conventional MR imaging in delineating structures when there is minimal joint fluid. In addition, vascularized or inflamed tissue will enhance with this method. Indirect MR arthrography can be used to rule in or diagnose abnormalities and to exclude abnormalities.
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              MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns.

              Elaine M. Caoili, David A. Jamadar, Anita S. Chong … (2007)
              The purpose of our study was to determine which wrist fractures are not prospectively diagnosed at radiography using CT as a gold standard and to identify specific fracture patterns. Through a search of radiology records from January 1 to December 31, 2005, 103 consecutive patients were identified as having radiographic and CT examinations of the wrist. After excluding incomplete or nondiagnostic examinations and those with a greater than 6-week interval between imaging studies, the final study group consisted of 61 wrist examinations in 60 patients. Two musculoskeletal radiologists and one emergency radiologist blindly reviewed CT examinations, and each bone (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, metacarpals, distal radius, distal ulna) was categorized as normal or fractured, with agreement reached by consensus. Each prospective radiographic report was categorized as either normal or fracture/equivocal for each osseous structure. Results were compared using the chi-square and Fisher's exact tests. In the proximal carpal row, lunate and triquetrum fractures were often radiographically occult (0% and 20%, respectively, detected at radiography); whereas in the distal carpal row, trapezoid, capitate, and hamate fractures were often occult (0%, 0%, and 40% detected at radiography, respectively). Hamate fractures were significantly associated with metacarpal fractures, and distal radius fractures were associated with scaphoid and ulna fractures. Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted. The location of a dorsal scaphoid avulsion fracture emphasizes the need for specific radiographic views or cross-sectional imaging for diagnosis.
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                Author and article information

                Contributors
                : +1-714-4568849 , +1-714-4567430 , hiroshi@uci.edu
                Journal
                Journal ID (nlm-ta): Skeletal Radiol
                Title: Skeletal Radiology
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 0364-2348
                ISSN (Electronic): 1432-2161
                Publication date (Electronic): 10 December 2009
                Publication date PMC-release: 10 December 2009
                Publication date (Print): September 2010
                Volume: 39
                Issue: 9
                Pages: 837-857
                Affiliations
                [1 ]Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
                [2 ]Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
                [3 ]Department of Radiological Sciences, University of California-Irvine, Irvine, CA USA
                [4 ]Department of Radiological Sciences, UC Irvine Medical Center, 101 City Drive South, Route 140, Orange, CA 92868 USA
                Article
                Publisher ID: 842
                DOI: 10.1007/s00256-009-0842-3
                PMC ID: 2904904
                PubMed ID: 20012039
                SO-VID: fb2c7641-f904-4dbc-82ca-674cfc8839c3
                Copyright © © The Author(s) 2009
                History
                Date received : 29 June 2009
                Date revision received : 14 November 2009
                Date accepted : 17 November 2009
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © ISS 2010

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ulnar side,wrist pain,imaging,treatment
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ulnar side, wrist pain, imaging, treatment

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