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Biomedical subjects

Louis A Gilula

Publications and source records attributed to Louis A Gilula.

At least 19 recordsLinked to original sources
PubMed2007

Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint.

OBJECTIVE: Although central tears of the triangular fibrocartilage are easily seen on imaging, peripheral tears of the ulnar attachment are frequently missed. The aim of this study was to evaluate the accuracy of MR arthrography of the distal radioulnar joint in depiction of peripheral tears of the triangular fibrocartilage. MATERIALS AND METHODS: Forty-one patients (18 women, 23 men; mean age, 38 years; age range, 18-60 years) underwent MR arthrography and wrist arthroscopy. For MR arthrography, iopamidol (300 mg I/mL) and gadopentetate dimeglumine (4 mmol/L) were injected into the distal radioulnar joint. Consensus review of both MR arthrograms and conventional arthrograms was performed by two experienced musculoskeletal radiologists. Presence or absence of communicating and noncommunicating tears of the ulnar attachment of the triangular fibrocartilage was recorded. Arthroscopy was used as the standard of reference for determining sensitivity, specificity, and accuracy in detection of tears of the ulnar attachment. RESULTS: At MR arthrography, communicating tear of the ulnar attachment was diagnosed in three patients, noncommunicating tear in 19 patients, and normal attachment in 19 patients. Arthroscopy revealed peripheral tear of the triangular fibrocartilage in all three patients with communicating tear, in 14 of 19 patients with noncommunicating tear, and in three of 19 patients with normal attachment. The sensitivity was 85% (17/20), specificity was 76% (16/21), and accuracy was 80% (33/41). CONCLUSION: MR arthrography of the distal radioulnar joint is accurate in depiction of peripheral tears of the ulnar attachment of the triangular fibrocartilage. These tears often appear as noncommunicating tears extending from the distal radioulnar joint into the triangular fibrocartilage.

Adolescent↗
PubMed2006

The diagnostic effect of various needle tip positions in selective lumbar nerve blocks: an analysis of 1202 injections.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To determine the effect of various needle tip positions on immediate postinjection pain in selective lumbar nerve blocks. SUMMARY OF BACKGROUND DATA: To our knowledge, no large study has examined the effect of various needle tip positions within or adjacent to the intervertebral foramen on immediate pain outcome. METHODS: A total of 1774 cases of intervertebral lumbar nerve blocks performed by our radiology staff between April 7, 1997 and May 31, 2002, were reviewed. Of the 1774 cases, 1202 met the study criteria (i.e., a single-level injection in an adult). The position of the needle tip and degree of immediate postinjection pain relief were examined. RESULTS: The blocks resulted in an average pain reduction of 4.14 U, as graded on a 0-10 ordinate scale (95% confidence interval 3.98-4.30). The degree of pain reduction was not associated with the needle tip position. CONCLUSIONS: Our results suggest that precise needle tip position within or adjacent to the intervertebral foramen made no difference on immediate pain reduction. These findings allow the practitioner more freedom in performing an injection. This study does not evaluate the long-term effects of various needle tip positions in selective lumbar nerve blocks.

Adolescent↗
PubMed2006

Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations.

PURPOSE: To retrospectively compare the presence or absence of carpal instability on radiographs with the findings of magnetic resonance (MR) arthrographic evaluation of intrinsic and extrinsic ligament tears in patients with chronic wrist pain. MATERIALS AND METHODS: The institutional review board approved this study and did not require informed consent. Signs of carpal instability were assessed on static and dynamic radiographs of the wrist obtained in 72 patients (24 female, 48 male; mean age, 36 years; age range, 14-59 years) with posttraumatic wrist pain. MR arthrography was subsequently performed. Two musculoskeletal radiologists independently analyzed the radiographs and MR images. Each intrinsic and extrinsic ligament was individually evaluated for the presence of a ligament tear. The extent of the tear also was recorded. Interobserver agreement regarding MR arthrographic findings was tested by calculating kappa statistics. Statistical comparison between radiography and MR arthrography was performed by using the Fisher exact test. RESULTS: Twenty-five triangular fibrocartilage complex, 18 (five partial, 13 complete) scapholunate ligament, and 25 (10 partial, 15 complete) lunotriquetral ligament tears were visualized. Twenty-two (all complete) extrinsic ligament tears were detected: two radial collateral ligament, 10 radioscaphocapitate ligament, and 10 radiolunotriquetral ligament tears. Interobserver agreement regarding intrinsic and extrinsic ligament tear detection at MR arthrography was excellent (kappa = 0.80). Nineteen patients had evidence of carpal instability on radiographs. Fourteen (52%) of 27 patients with at least one complete intrinsic lesion had no sign of carpal instability. On the other hand, the association of scapholunate ligament and/or lunotriquetral ligament and extrinsic ligament tears was significantly correlated (P < .001) with carpal instability at radiography. CONCLUSION: The presence or absence of carpal instability on radiographs depends on the association between intrinsic and extrinsic ligament tears-even partial ones-rather than on the presence of intrinsic ligament tears alone, even when the tears are complete.

Adolescent↗
PubMed2006

Osteoporotic compression fractures: outcomes after single- versus multiple-level percutaneous vertebroplasty.

PURPOSE: To compare single- and multiple-level percutaneous vertebroplasty (PV) in terms of pain relief, activity level, and analgesic use in patients with osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained, and the study was HIPAA compliant. One hundred seventy-three patients (mean age at treatment, 73.8 years +/- 11.9 [standard deviation]) with 422 symptomatic osteoporotic VCFs underwent 204 treatment sessions for over 4 years. Pain immediately before and after PV was measured by using a visual analogue scale (VAS). Pain degree, activity level, and analgesic use were assessed at 2 weeks and 1, 3, 6, 12, and 24 months after PV by using telephone interview questionnaires. Data were analyzed by using a combination of paired t tests, analysis of variance, contingency tables, and chi2 tests. RESULTS: Findings of 172 PV treatment sessions for 149 patients (mean age at treatment, 73.4 years +/- 12), 110 (74%) of whom were women, were assessed; 32 treatment cases were lost to follow-up or lost owing to death. A single fracture level was treated at 65 sessions; two fracture levels, at 52 sessions; and three or more fracture levels, at 55 sessions. The mean VAS pain score decreased significantly (P < .001), from 76 +/- 21 before to 19 +/- 27 immediately after PV. Of the outcomes reported at 24 months, 82% (64 of 78 treatment sessions) were marked to complete resolution of the initial pain, 51% were complete cessation of analgesic use, and 51% were increased activity levels. These results did not differ greatly over time or when stratified into groups according to the number of fracture levels treated. CONCLUSION: PV performed at a single fracture level and that performed at multiple fracture levels were equally effective in facilitating long-term pain relief, increased activity level, and decreased analgesic use in patients with osteoporotic VCFs.

Aged↗
PubMed2006

Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty.

BACKGROUND: There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function. METHODS: Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities. RESULTS: Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05). CONCLUSIONS: Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year.

Adult↗
PubMed2006

Response of nonmidline pain to percutaneous vertebroplasty.

OBJECTIVE: The purpose of this study was to determine the prevalence of nonmidline symptoms in patients undergoing percutaneous vertebroplasty and the response of these symptoms to vertebroplasty. MATERIALS AND METHODS: This is a retrospective study performed through examination of patient records, baseline questionnaires, demographic sheets, follow-up questionnaires, reports from telephone follow-up, and pain location diagrams completed before and after percutaneous vertebroplasty. Data were gathered from 350 patient encounters, 686 vertebroplasty procedures, and 288 patients. After determining the prevalence of nonmidline pain, analysis of acquired data was performed to determine the efficacy of vertebroplasty in relieving nonmidline pain. RESULTS: Nonmidline pain was present in 240 of 350 patient encounters. Major symptom areas were the ribs; hip, groin, and buttocks; and legs and thighs. Lesser areas of nonmidline symptoms were the abdomen, shoulders, and waistline. Overall there was improvement in nonmidline pain in 83% of the procedures. CONCLUSION: Most patients presenting for percutaneous vertebroplasty have nonmidline pain. Vertebroplasty reduced or eliminated nonmidline pain in 76-92% of the patients in whom it was reported. Procedures involving lumbar vertebrae tended to be successful less often than others, but even in these patients the procedure was successful in approximately 75%.

Adult↗
PubMed2006

A novel approach to flexor hallucis longus tenography.

OBJECTIVE: This article presents a technically simple and more accurate approach to flexor hallucis longus (FHL) tenography than any we found reported in the literature. CONCLUSION: Tenography is used to evaluate and treat tenosynovitis. Standard FHL tenography protocol involves either direct percutaneous access of the FHL synovial sheath posterior to the medial malleolus or indirect filling of the FHL sheath from an injection of the flexor digitorum longus (FDL) tendon sheath, which often communicates with the FHL tendon sheath. However, with these methods, difficulty entering the FHL sheath may be encountered. We adapted our technique to access the FHL sheath as it courses below the sustentaculum talus. Our early experience with five cases using this technique reflects a 100% success rate with accurate needle placement within the FHL tendon sheath, thereby improving procedural efficiency.

Adult↗
PubMed2006

Management of recalcitrant osteoarthritis of the atlanto-axial joint.

The medical records and radiographs of 17 patients with recalcitrant pain secondary to C1-C2 osteoarthritis were independently reviewed. All patients were treated by the senior author (K.D.R.). Initial treatment included physical therapy, nonsteroidal anti-inflammatory drugs, and soft collar immobilization. If non-responsive, patients were referred to a single radiologist for injection of the involved C1-C2 joint(s). If symptoms persisted, then transarticular screw fixation and Magerl wire fixation with structural iliac crest bone graft was performed. Postoperatively, all patients were placed in a soft collar. Postoperative anteroposterior (AP), lateral, flexion/extension, and open-mouthed odontoid radiographs were taken at 6 weeks, 3 months, and 1 year. Three independent observers assessed all radiographs for fusion. Fusion was noted by radiographic evidence of bridging bony trabeculae across the C1-C2 joint and/or bridging bone from the posterior arch of C1 to the C2 spinous process. Patient satisfaction improved significantly whether they were treated by corticosteroid injection or surgically.

Adrenal Cortex Hormones↗
PubMed2005

Percutaneous vertebroplasty: an update.

Percutaneous vertebroplasty is an imaging-guided interventional technique in which surgical polymethylmethacrylate is injected via a large bore needle into a painful compressed vertebral body. This technique is safe and effective, and provides increased strength and pain relief in vertebrae weakened by bone diseases. Among the current indications for vertebroplasty are intractable nonradicular pain caused by compression fractures due to osteoporosis, myeloma, metastasis, and aggressive vertebral hemangioma. Contraindications include bleeding disorder, unstable fracture, and lack of definable vertebral collapse. The preprocedural evaluation, technique, complications, and expected results of performing this procedure are also reviewed.

Adult↗
PubMed2005

Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections.

BACKGROUND: A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution. METHODS: Between October 1999 and June 2003, we performed 1036 fluoroscopically guided extraforaminal cervical nerve blocks in 844 patients. Plain radiographs documenting the procedure were made as part of the standard quality-assurance protocol. An independent observer who was uninvolved with the procedures reviewed a prospectively kept database on all patients. We subsequently reviewed the patient records to identify complications. RESULTS: There were no catastrophic complications such as vessel damage, paralysis, or death. Overall, fourteen patients (1.66%) had a minor complication in association with the procedure. With the numbers available, the rate of complications associated with pdeep injection (798 blocks) was not significantly different from that associated with shallow injection (238 blocks) (1.89% compared with 0.84%). However, the rate of complications associated with anterior placement of the needle tip (thirty-three blocks) was higher than that associated with ideal placement of the needle tip (904 blocks) (6.06% compared with 1.55%) (p = 0.04). CONCLUSIONS: No catastrophic complications occurred in this series of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on frontal-view radiographs was not associated with complications, although the anterior positioning of the needle as seen on lateral-view radiographs was associated with minor complications. Our results suggest that, with our technique, cervical nerve blocks are relatively safe procedures.

Anti-Inflammatory Agents↗
PubMed2005

Correlation between preprocedural MRI findings and clinical outcomes in the treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty.

OBJECTIVE: The purpose of our study was to correlate findings of prevertebroplasty MRI with outcomes in the treatment of chronic osteoporotic compression fractures. MATERIALS AND METHODS: Forty-five patients with osteoporotic spinal compression fractures of more than 1 year's duration were treated with vertebroplasty. Changes in pain and mobility were assessed by follow-up of 1-28 months. Preprocedural MR images were reviewed using the Modic criteria and were correlated with outcomes. RESULTS: Fifteen patients (33%) had marrow edema on MRI and 30 (67%) of the 45 patients did not. All 15 of the patients with edema had clinical benefit: six patients (40%) achieved complete relief and nine (60%) experienced symptom improvement. Ten patients (67%) had improvement in mobility, and the remaining five patients (33%) had no change. Of patients with no marrow edema (n = 30), five (17%) had complete resolution of pain, 19 (63%) were improved, and six (20%) were unchanged. None had worsening of their symptoms. Mobility was improved in 17 (57%) and unchanged in 10 (33%). Mobility was diminished in three patients (10%). In two cases, impaired mobility was due to causes other than spine disorders. CONCLUSION: Most (87%) of the 45 patients with compression fractures older than 1 year derived clinical benefit from vertebroplasty irrespective of MRI findings. Although 100% of patients with bone marrow edema had clinical benefit, no direct correlation was seen between symptom resolution and the presence of edema on preprocedural MRI. In our experience, absence of abnormal marrow signal does not definitively predict the outcome of vertebroplasty in chronic fractures.

Aged↗
PubMed2004

Percutaneous vertebroplasty for malignant compression fractures with epidural involvement.

PURPOSE: To evaluate safety and effectiveness of performance of percutaneous vertebroplasty (PVP) in patients with malignant compression fractures and involvement of the epidural space. MATERIALS AND METHODS: PVP was performed in 50 patients with metastatic disease or multiple myeloma between June 1998 and April 2002. Twenty-five women (mean age, 62.3 years; range, 38-85 years) and 25 men (mean age, 63.1 years; range, 37-92 years) were included. Cases were retrospectively reviewed. Patients who had undergone cross-sectional imaging were classified into three groups. First group had no epidural involvement; second group, mild epidural involvement without contact with spinal cord or nerve roots; third group, moderate involvement and contact with spinal cord or nerve roots. Procedural safety was evaluated with review of all post-PVP complications and their treatment. Effectiveness was evaluated with follow-up phone calls for assessment of change in pain level and activity after PVP. Follow-up calls were performed at 1 day; 2 weeks; 1, 3, and 6 months; and 1 and 2 years. Differences between groups were assessed with singly ordered Kruskal-Wallis test. RESULTS: Fourteen patients were classified in the first group, 18 in the second, and 18 in the third. There were no significant differences in pain or mobility outcomes among groups. At the last follow-up call, 41 (82%) of 50 patients reported improvement in pre-PVP pain. Six (12%) reported no change, and three (6%) reported increased pain. After PVP in 26 (52%) patients, there was a period of increased mobility; in 19 (38%), no improvement in mobility occurred; and in five (10%), decreased mobility was reported. Complications included acute increased pain or new areas of pain in seven (14%) patients. None of these required surgery; four were treated with nerve root block; two, with central epidural injection; and one, with overnight intravenous steroids. CONCLUSION: PVP can be performed safely and effectively with conscious sedation in patients with malignant compression fractures and epidural involvement.

Adult↗
PubMed2004

Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation.

PURPOSE: To compare anatomic tilt radiographs with standard posteroanterior (PA) and lateral radiographs for their efficacy in detecting screw penetration of the distal radius articular surface. METHODS: Twenty-four cadaveric human forearm specimens had fixation with a dorsal distal radius plate and screws. Three groups were evaluated: (1) no articular surface screw penetration, (2) radial-sided articular screw penetration, and (3) ulnar-sided articular screw penetration. Standard PA and lateral views and anatomic tilt PA and lateral views were taken of each specimen. Three observers reviewed both individual (PA or lateral) and paired (PA and lateral) radiographs. These radiographs were evaluated based on whether or not articular penetration had occurred. A number between 1 and 5 was assigned to represent the degree of certainty of their assessment. The accuracy of the observers was calculated to determine if screw penetration of the articular surface had occurred and, if so, which screw had penetrated the joint. The sensitivity and specificity of each view, interobserver reliability, and the reviewers' confidence in evaluating presence or absence of screw penetration were calculated. RESULTS: The use of anatomic tilt lateral views significantly improved the overall accuracy, (0.93 vs 0.64), sensitivity (0.98 vs 0.77), and specificity (0.83 vs 0.38) of the detection of articular screw penetration when compared with standard lateral views. PA and lateral anatomic tilt views, when viewed together, significantly improved (p <.001) the accuracy of each observer's determination of the position of the penetrated screw (0.90 vs 0.67). In addition, anatomic tilt views significantly improved the confidence of the reviewers in their more accurate observations (4.7 vs 3.3, p <.05). CONCLUSIONS: Anatomic tilt PA and lateral radiographs of the distal radius are an accurate and clinically useful tool for the evaluation of both presence and location of screw penetration of the articular surface after dorsal plating.

Bone Plates↗
PubMed2004

Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty.

OBJECTIVE: Most fractures treated with percutaneous vertebroplasty are subacute and less than 1 year old. We report our experience treating chronic vertebral fractures with vertebroplasty. MATERIALS AND METHODS: Our database identified 41 patients with symptomatic fractures more than 1 year old. These patients were categorized into subgroups determined by fracture age: 12 months 1 day-24 months (n = 16) or more than 24 months 1 day (n = 25). Changes in pain and mobility for the study group were compared with those in 49 patients with fractures less than 1 year old. RESULTS: Thirty-three (80%) of the 41 patients in the study group had improvement in pain-seven (17%) had complete and 26 (63%) had partial relief. Forty-five (92%) of the 49 control group patients had improvement in pain-24 (49%) had complete and 21 (43%) had partial relief. The number of patients achieving partial or complete relief of pain was not statistically different between groups (p > 0.05), although complete relief was significantly more frequent in the control group (p = 0.002). Twenty patients (49%) in the study group versus 34 patients (69%) in the control group had improved mobility after vertebroplasty (p = 0.047). Patients with fractures 12 months 1 day-24 months old had improvement in mobility similar to that in patients in the control group (p = 0.962). Fractures more than 24 months 1 day old were associated with significantly less improvement in mobility (p = 0.006). CONCLUSION: Most patients with fractures more than 1 year old will experience clinical benefit from vertebroplasty. Complete relief of pain is more likely when less mature fractures are treated.

Adult↗
PubMed2004

Percutaneous vertebroplasty in patients with spinal canal compromise.

OBJECTIVE: The American College of Radiology Standard for Performance of Percutaneous Vertebroplasty lists as relative contraindications to the procedure conditions causing "significant spinal canal compromise." We believe percutaneous vertebroplasty can be performed safely and efficaciously in individuals without radicular symptoms who present with canal compromise, with or without cord compression. MATERIALS AND METHODS: We reviewed all vertebroplasties performed at our institution over the past 4 years. Cases in which vertebroplasty was performed at levels showing complete effacement of the epidural space, particularly those with cord compression, were included in the review. Follow-up data obtained from questionnaires routinely sent to our vertebroplasty patients were used to evaluate symptomatic response in this subset of patients as well as the occurrence of any complications. RESULTS: Of 686 levels treated over the past 4 years, 26 levels in 23 patients qualified for our review. Follow-up ranged from 6 months to 2 years. Patients were asked to rate the degree of their original pain as follows: gone, better than, the same as, or worse than before the procedure. Of the 23 patients, five (22%) reported complete resolution of pain, 15 (65%) reported their symptoms to be better, and three (13%) reported no appreciable change. No complications with clinical sequelae were encountered. CONCLUSION: Percutaneous vertebroplasty can be performed safely at levels showing spinal cord compression in patients without radicular signs. Most patients (87%) in our series showed some improvement or complete eradication of their symptoms. No patient reported worsening symptoms.

Aged↗
PubMed2003

Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors.

PURPOSE: To evaluate different types of polymethylmethacrylate (PMMA) leakage and patient-related factors in relation to clinical midterm (1-24-month) outcome after vertebroplasty. MATERIALS AND METHODS: Standardized four-view radiographs obtained during 363 vertebroplasties in 181 treatment sessions in 152 patients were reviewed (121 patients with osteoporotic fractures, 30 with malignant disease, and one with hemangioma). Four types of PMMA leakage and other potential predictors (patient age and sex, treated region, number of vertebral levels injected, preprocedural pain, PMMA volume per vertebra) were related to postprocedural pain response and midterm outcome after vertebroplasty. chi2 and Kruskal-Wallis tests were used for statistical analysis. The mean follow-up period was 8.8 months (range, 1-24 months). RESULTS: At the time of discharge after the procedure, pain was absent after 106 of the 181 sessions (58.5%), better after 50 (27.6%), and the same after 25 (13.8%). In 258 of the 363 treated vertebral levels, at least one type of leakage was found. None of the evaluated factors were related significantly to postprocedural pain response, including PMMA leakage. Pain response at midterm outcome was strongly related to postprocedural treatment success, however (P <.001). CONCLUSION: Small to moderate amounts of PMMA may escape from the vertebral body with no significant effect on therapeutic success. Immediate postprocedural pain relief is the best predictor of midterm clinical outcome after vertebroplasty.

Aged↗
PubMed2003

Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers.

PURPOSE: To describe the normal magnetic resonance (MR) arthrographic anatomy of the major carpal ligaments (excluding scapholunate and lunotriquetral ligaments) and their osseous attachments by using standard imaging planes. MATERIALS AND METHODS: MR images of 22 wrists derived from fresh human cadaveric hands were obtained after tricompartmental arthrography. The MR arthrographic appearance of the carpal ligaments and their bone attachments were analyzed and correlated to those seen on anatomic sections. Two readers determined in consensus which was the best plane to observe the course and attachment sites for each ligament. They further analyzed the size and sites of attachment of these ligaments in two orthogonal planes chosen for optimal viewing. RESULTS: Each ligament was well seen as a hypointense linear structure with MR arthrography. The radioscaphocapitate, radiolunotriquetral, radioscapholunate, dorsal radiotriquetral, palmar scaphotriquetral, and dorsal scaphotriquetral ligaments were best evaluated in the transverse plane. The palmar and dorsal ulnotriquetral and ulnolunate ligaments were best visualized in the sagittal plane. The radial collateral ligament was best analyzed in the coronal plane. The attachment sites of all ligaments were best analyzed either in the transverse or sagittal planes. CONCLUSION: MR arthrography allows visualization of the carpal ligaments. Detailed knowledge of the normal appearance of these ligaments can serve as a baseline for future studies in which MR arthrography is used to characterize wrist instability.

Aged↗