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At least 235 records · Page 13Linked to original sources

PubMed2000

Indirect wrist MR arthrography: the effects of passive motion versus active exercise.

PURPOSE: In the wrist, to determine whether passive motion or active exercise yields a better indirect MR arthrographic effect following intravenous gadolinium administration. DESIGN AND PATIENTS: Twenty-six consecutive patients were studied by indirect wrist MR arthrography. In half active exercise and in half passive motion was performed. Four regions of interest were studied including the distal radioulnar joint, the radiocarpal joint, the midcarpal joint, and the triangular fibrocartilage. Ranges and means of signal intensity were calculated. Surgical follow-up was performed in 22 patients. RESULTS: The joint fluid intensity was greatest in the distal radioulnar joint. Fluid signal intensity was greater and more consistent in the passive motion group although the results did not achieve statistical significance. Imaging accuracy appeared similar in the two groups and was excellent for the triangular fibrocartilage (100%) and scapholunate ligaments (96%). CONCLUSION: Active exercise and passive motion yield similar degrees of wrist arthrographic effect, but the effect of passive motion is somewhat more consistent. Preliminary data show good accuracy for internal derangements.

Adolescent↗

PubMed2000

[Magnetic resonance imaging of the wrist--comparison of high resolution pulse sequences and different fat signal suppression techniques in cadavers].

PURPOSE: To evaluate high resolution sequences with and without fat-suppression techniques for MR imaging of the wrist. MATERIALS AND METHODS: 10 cadaver wrist specimens were imaged with 12 MR sequences (SE: 400 ms/20 ms, TSE: 3000 ms/119 ms/17 ms, fatsat (FS) TSE: 3000 ms/17 ms and 3000 ms/45 ms, STIR: 2619 ms/29 ms/160 ms, DESS 3D: 43.7 ms/9 ms/35 degrees FS and 25.4 ms/9 ms/35 degrees water excitation (WE), CISS 3D: 12.2 ms/5.9 ms/40 degrees and FLASH-sequences: 53 ms/11 ms/40 degrees FS, 23 ms/11 ms/40 degrees WE and 45 ms/11 ms/30 degrees FS) at 1.5 T. Slice thickness was 3 mm, FOV 80 x 70 mm (pixel size 0.31 x 0.31 mm). Signal intensity was measured by an ROI in bone marrow, fluid, hyaline cartilage, scapholunate (SL) ligament and triangular fibrocartilage and S/N- and C/N-ratios were calculated. Additionally, a visual evaluation was performed. RESULTS: The highest homogeneity and the least artifacts were achieved by the T1-w SE sequence. For the STIR and PD-FS TSE sequence high rankings were found for the detection of free water. The PD FS sequence had high ranking also for visualization of the SL ligament and the triangular fibrocartilage. The best sequence for the assessment of hyaline cartilage was the FLASH-FS sequence. For detailed analysis of bony structures the CISS sequence performed best. CONCLUSION: The isolated use of a PD-FS-TSE sequence enables for evaluation of all clinically relevant structures at the wrist. Dedicated questions for hyaline cartilage are answered best by the use of a FLASH 3D-FS sequence. Selective water excitation reduces acquisition time to 60%, nevertheless FS sequences are still diagnostically superior to WE sequences.

Adipose Tissue↗

PubMed1987

Attritional lesions of the wrist joint.

One hundred anatomic specimens of wrists were dissected to assess the incidence of perforations in the ligaments and triangular fibrocartilage of the wrist. The age of the specimen appeared to have a positive correlation with the incidence of perforations. There were no identifiable lesions in the wrists of specimens that were 45 years of age or younger. The incidence of perforations increased in specimens 60 years of age or older to 33% for the scapholunate interosseous ligaments, 27.6% for the lunotriquetral interosseous ligaments, and 27.6% for the disk of the triangular fibrocartilage of the wrist.

Adolescent↗

PubMedDate not supplied

Proximal wrist imaging.

Ligamentous injuries to the triangular fibrocartilage are often difficult to evaluate. The plain film examination along with the physical examination serves as the basis for the initial assessment of most wrist injuries. Ligamentous injuries of the wrist often present at the subacute or chronic state with the physical examination and plain films being insufficient to make a definitive diagnosis in many cases and the plain film radiographic exam being of little additional value. This paper reviews the triangular fibrocartilage complex including the underlying anatomy and biomechanics, along with its radiographic evaluation by modern imaging techniques.

Carpal Bones↗

PubMed1998

The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation.

Posttraumatic limitation of forearm rotation can be the result of pathology at any location along the forearm axis. Scar contracture of the distal radioulnar joint (DRUJ) capsule, independent of the triangular fibrocartilage complex (TFCC), is one of the sources that may influence the pronosupination arc. We dissected the wrists of 8 fresh-frozen cadaver specimens to characterize the precise anatomy, relationships, and dynamic characteristics of the entire DRUJ capsule. Additionally, we performed surgical DRUJ capsulectomy in 9 patients with recalcitrant limited forearm pronosupination that was unattributable to dysfunction at any other anatomic forearm location. We conclude that (1) the DRUJ capsule is a defined entity, separate from the triangular fibrocartilage, that is highly specialized to accommodate the distal ulna in forearm rotation; (2) in patients who have restored osseous anatomy after trauma, but have failed to regain pronosupination after maximal rehabilitation, the DRUJ capsule can be identified as the source of the limitation; and (3) DRUJ capsulectomy can markedly improve the arc of forearm rotation in carefully selected patients.

Biomechanical Phenomena↗

PubMed2002

[Imaging diagnostics of the wrist: MRI and Arthrography/Arthro-CT].

PURPOSE: To evaluate the use of magnetic resonance imaging (MRI) compared with arthrography and arthro-CT (AG/ACT) in patients with wrist pain. METHODS: MRI and arthrography/arthro-CT (AG/ACT) of the wrist joint were retrospectively evaluated in 346 patients over a three-year period. Imaging findings were correlated to surgical results (n = 78) or clinical course in an at least 6-month follow-up. RESULTS: For tears of the triangular fibrocartilage, arthrography, arthro-CT, and MRI demonstrated a sensitivity and specificity of more than 0.96. Only the positive predictive value was superior for arthrography/arthro-CT (0.99 and 0.98, respectively) compared with MRI (0.94). Arthrography was superior for functional diagnosis of scapho-lunate ligament tears (n = 25). Ulno-lunate and ulno-triquetral ligament defects were demonstrated more exactly by arthrography. Traumatic osseous defects, particularly scaphoid fractures (n = 33) and avascular necrosis (n = 17), were better diagnosed using MRI. CONCLUSION: For suspected lesions of the triangular fibrocartilage complex, AG/ACT is slightly more reliable than MRI. However, MRI was found to be highly accurate in diagnosing TFC tears, and is superior to AG/ACT in detecting traumatic and vascular lesions of the wrist.

Arthrography↗

PubMed1985

Arthrotomography of the wrist: an experimental and preliminary clinical study.

Experimental arthrotomography including posteroanterior and lateral projections was completed in 18 fresh-frozen wrists from cadavers with an average age of 65 years at death. Arthrotomographic findings were correlated with anatomic dissections. Three types of defects of the triangular fibrocartilage complex were clearly defined in 38% of wrists. Chondromalacia was present in 24% of wrists, in all cases on the ulnar half of the proximal surface of the lunate bone. The palmar radiocarpal ligaments (radiocapitate and radiotriquetral) were visible in all specimens. Experimental arthrotomography appears to be useful in defining the nature and location of soft tissue pathology in clinical practice. Clinical arthrotomography was performed in 16 patients, all with a syndrome of chronic wrist pain. Pathologic findings were observed in 11 wrists, including four perforations of the triangular fibrocartilage complex, two cases of chondromalacia of the lunate, one tear in each of the scapholunate and lunotriquetral ligaments, three occult palmar ganglia, and one recurrent dorsal ganglion. The soft tissues in five wrists were normal. The preliminary clinical experience with wrist arthrotomography has yielded results that have significantly affected the care of patients, including the planning of operative treatment and patient counseling.

Adolescent↗

PubMed1993

Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography.

OBJECTIVE: Communicating defects shown by wrist arthrography often correlate poorly with the location of the patient's symptom(s). No study of wrist arthrography in which noncommunicating defects have been isolated, described, and correlated with the site of patients' symptoms has been reported. The aim of this study was to correlate the site(s) of patients' pain and the location(s) of noncommunicating defects shown by wrist arthrography. MATERIALS AND METHODS: One hundred noncommunicating capsular defects and incomplete defects of the interosseous ligaments and triangular fibrocartilage in 82 patients were identified from 462 three-compartment wrist arthrograms. Correlation between the sites of pain and sites of the noncommunicating defect was described as: (1) exact correlation, (2) ulnar/radial side correlation, (3) ambiguous correlation, or (4) no correlation. Statistical analysis was performed for each type of defect separately, in aggregate for patients who had more than one defect, and by separate analysis using patients' age (less than or greater than 30 years old). RESULTS: Capsular defects were detected in 65 patients, incomplete perforations of the triangular fibrocartilage in 28 patients, and incomplete defects of the scapholunate and lunotriquetral ligament in three patients each. No statistically significant correlation was found between individual defects and symptoms or between the site(s) of symptoms and patterns of multiple noncommunicating defects. Further, age did not influence the degree of correlations (chi 2 = 0.000-0.476, p values = 0.49-1.00). CONCLUSION: Attribution of patient's symptoms to noncommunicating defects shown by wrist arthrography is not reliable. Cases in which site-specific arthrographic defects directly correlate may be fortuitous. Additional studies will be necessary to determine the future role of wrist arthrography in the evaluation of the painful wrist.

Adult↗

PubMed1996

The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation.

A biomechanical cadaver study was performed to evaluate the effect of dorsally angulated distal radius fractures on the distal radioulnar joint. Frykman I distal radius fractures were simulated, and laxity measurements were taken with and without sectioning the triangular fibrocartilage complex and the interosseous membrane. The findings of this study were threefold. First, measured in terms of radial diastasis, incongruency of the distal radioulnar joint occurred with increasing dorsal tilt of the distal radius. It became most dramatic with a change of more than 20 degrees of dorsal angulation of the distal radius. This corresponds to approximately 10 degrees of dorsal tilt of the articular surface of the distal radius, as measured on an x-ray film. Second, increased dorsal angulation caused interosseous membrane tightness and limited maximum pronation and maximum supination. Third, distal radioulnar joint dislocation did not occur until both the triangular fibrocartilage complex and interosseous membrane were sectioned. These results reveal the importance of anatomic reduction of the distal radius fracture and evaluation of damaged soft tissue structures.

Biomechanical Phenomena↗

PubMed2005

Diagnosis and treatment of longitudinal instability of the forearm.

Radio-ulnar dissociation can result from high-injury trauma that the compressive forces traverse the wrist forearm and elbow. This injury can be thought of as an "unhappy triad" of radial head fracture, triangular fibrocartilage complex failure, and a tear of the interosseous membrane. The radius is the primary stabilizer of the forearm with the forearm interosseous membrane enabling load sharing between the radius and the ulna. The central one-third of the interosseous membrane is 3 times stronger than the membranous portion and approaches the strength of the anterior cruciate ligament for determining interosseous membrane injury. Imaging studies with proven diagnostic efficacy include magnetic resonance imaging and ultrasound. Surgical treatment should be considered when circumstances imply longitudinal instability of the forearm. Surgical treatment includes open reduction/internal fixation or prosthetic replacement of the radial head as well as repair of the disrupted triangular fibrocartilage complex. Successful treatment of radioulnar dissociation is predicated on early diagnosis of the condition.

Biomechanical Phenomena↗

PubMed1990

Digital subtraction arthrography of the wrist.

Digital subtraction arthrography of the wrist was used to identify abnormalities in eighty-six (60 per cent) of 139 patients during a fifteen-month period. Multiple abnormalities were noted in thirty-four (25 per cent) of the wrists. The clinical signs and symptoms in the eighty-six wrists did not always correlate with the defects that were seen on the arthrograms. Three of five patients who had an isolated tear of the scapholunate ligament, six of thirteen who had an isolated tear of the lunotriquetral ligament, and seven of nineteen who had an isolated tear of the triangular fibrocartilage complex also had signs and symptoms on the opposite side of the wrist. Many of the lesions that were seen on arthrography may have been serendipitous, degenerative, or unrelated to a specific injury. There was a high prevalence of positive ulnar variance in patients who had at least one ulnar abnormality. Capsular tears, most often seen on the radiovolar aspect of the wrist, were best outlined by contrast medium injected into the radiocarpal joint. The arthroscopic findings differed from the arthrographic findings in five of the twenty patients in whom both studies were done. The three-compartment technique of injection is a valuable diagnostic tool. Injections of contrast medium into the distal radio-ulnar joint outlined five of thirteen tears of the triangular fibrocartilage complex that were not seen after injection into the radiocarpal joint. Of the eleven tears that were seen after injection into the radiocarpal joint, five were not seen when contrast medium was injected into the distal radio-ulnar joint.

Adolescent↗

PubMed1995

Arthrography of the wrist. Assessment of the integrity of the ligaments in young asymptomatic adults.

Fifty-two asymptomatic adults who were between twenty and thirty-five years old had arthrography of the wrist with use of a single injection into the radiocarpal joint. The purpose of the study was to evaluate the integrity of the triangular fibrocartilage, the scapholunate ligament, and the lunotriquetral ligament. Contrast medium was injected under fluoroscopic guidance, and posteroanterior and lateral radiographs of the wrist were made after the subjects had performed exercises of the wrist. No patient who had a history of trauma to the wrist, pain in the wrist, or inflammatory arthritis was included in the study. All of the subjects had an examination of both upper extremities that included measurement of the active motion of the wrist with a goniometer, strength-testing with a Jamar dynamometer, ballottement and testing for impingement, and palpation for tenderness. Plain radiographs were evaluated, and the ulnar variance was recorded. The arthrograms revealed an abnormal communication of the contrast medium in fourteen wrists (27 per cent), and four of the fourteen had multiple areas of communication. The abnormal communication was through the triangular fibrocartilage alone in six wrists, the scapholunate ligament alone in two wrists, the lunotriquetral ligament alone in two wrists, and in more than one of these areas in four wrists. A positive arthrogram was associated with a greater positive ulnar variance. All of the subjects had symmetrical motion of the wrists and grip strength, and none of them had tenderness in the wrist. There were no complications related to the arthrography. Perforation of a ligament in the wrist is common in young asymptomatic adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Distal ulnar recession for disorders of the distal radioulnar joint.

Thirty-six wrists of 35 patients were treated with distal ulnar recession for pain and limitation of motion associated with chondromalacia of the ulnar head, triangular fibrocartilage complex tears, ulnocarpal impingement, and instability of the distal radioulnar joint. Contributing factors were positive ulnar variance in 31 wrists, fracture of the distal radius in five, sprains in 14, premature closure of the distal radial epiphysis in five, and lax ligamentous habitus in five. The ages of the patients averaged 33 years. Clinical findings were local tenderness, crepitus, and instability evident by a positive "piano key" effect. Roentgenographic findings were positive ulnar variance (29 of 36), zero ulnar variance (four), negative ulnar variance (three), positive arthrogram (11 of 19), and "forme fruste" Madelung's deformity (two). The surgical procedure is a modification of the Milch cuff resection with the use of a dynamic compression plate. Recession ranged from 2 to 13 mm (average of 4 mm). Findings at surgery included chondromalacia of the ulnar head (19), tears of the triangular fibrocartilage complex (11), and excessive mobility of the ulnar head (10). At an average follow-up of 24.5 months, results were excellent in 7 wrists, good in 21, fair in four, and poor in four. Poor results in two wrists were upgraded to good after osteosynthesis of a nonunion in one and recessional osteotomy of the radial sigmoid notch in the other. Ulnar recession offers a less destructive alternative to disorders of the distal radioulnar joint than the Darrach resection.

Adolescent↗

PubMed1998

[Significance of three-compartment digitalized arthrography in the diagnosis of post-traumatic instability of the radiocarpal complex].

INTRODUCTION: The radiocarpal complex is the structure formed by the distal radioulnar, radiocarpal and midcarpal joints; these joints are compartments, each anatomically separated from the other. An appropriate arthrographic study with three-compartment injection better demonstrates the capsuloligamentous structures than conventional radiography. The diagnosis of any condition in this complex may therefore be easier to make. MATERIAL AND METHODS: From January 1993 to December 1996, twenty-six patients with mild to moderate wrist and carpal sprain and previously examined with radiography, were submitted to digital three-compartment arthrography at the Imaging Diagnostic Service of the Rizzoli Orthopedic Institute. Of 17 patients with previous radiographic diagnosis of scapholunar diastasis, 1 patient had a negative radiographic picture, 15 had an incomplete tear of the scapholunar ligament and 1 a double injury of the scapholunar and triquetro-lunar ligaments. Of 10 patients with mild to moderate triquetro-lunar diastasis, 8 had and arthrographic picture of pyramido-lunar ligament injury, 1 had a double injury of the triquetro-lunar and scapholunar ligaments and another one of triangular fibrocartilage complex injury. RESULTS: Three-compartment contrast agent injection permitted the diagnosis of interruptions between the different compartments and more injuries of scapholunar and triquetro-lunar ligaments than single compartment injection. We examined 27 patients with small arch injuries with three-compartment digital arthrography and found scapholunar diastasis in 17 (63%) and triquetro-lunar diastasis in 10 (37%). In the first group of 17 patients, three-compartment arthography demonstrated more scapholunar ligament injuries (13 cases) than single compartment injection; image subtraction, allowed by the digital technique, showed 2 injuries not visible otherwise. Injuries of the scapholunar and triquetro-lunar ligaments were demonstrated with and without digital subtraction. One patient had no ligament injury. In the other group of 10 patients, three-compartment arthrography showed more triquetro-lunar ligament injuries (6 cases) than single compartment injection; image subtraction demonstrated 2 injuries not visible otherwise in this group too. Injuries of the scapholunar and triquetro-lunar ligaments were demonstrated with and without digital subtraction. The injury of triangular fibrocartilage and contrast agent leak into soft tissues were shown in one patient with the injection of the distal radioulnar compartment alone, regardless of image subtraction. CONCLUSIONS: Arthrography, combined with conventional static and dynamic radiography, increases the detection rate of capsuloligament joint defects in the wrist-carpal complex. The three-compartment digital technique combines the advantages of fluoroscopic monitoring and videorecording and allows real time imaging of the contrast agent flow during injection in different compartments. Moreover, the digital technique permits the complete study of all joints in a single session, while image subtraction reveals even minimal ligament changes. This technique becomes therefore a fundamental tool for surgical planning.

Adult↗

PubMed1999

Degeneration of the scaphoid-trapezium joint: a useful finding to differentiate calcium pyrophosphate deposition disease from osteoarthritis.

This study aimed to determine whether osteoarthritis of the scaphoid-trapezium joint (ST osteoarthritis) is associated with calcium pyrophosphate deposition disease (CPDD) in an elderly population with or without concomitant polyarthritis of the finger joints (FIPO). An age- and gender matched case-control study was performed at a university hospital outpatient clinic. Cases and controls were identified from a clinical registry. The case ascertainment process included: (1) chart review for evidence of pyrophosphate crystals from arthrocentesis and/or cartilage calcifications and (2) blinded reading of hand X-rays by three observers for calcification of the triangular fibrocartilage and/or cartilage calcification around the spatium triangulare. Osteoarthritis was graded from 0 to 4 according to the Standard Atlas of Radiographs. The association of ST osteoarthritis with the diagnosis was examined using chi2 tests or the Wilcoxon rank sum test as appropriate. From 65 potential cases, 30 fulfilled the inclusion/exclusion criteria whereas from 185 potential controls, 81 fulfilled the inclusion/exclusion criteria. Thirty controls were matched to cases for gender and age. ST osteoarthritis was much more severe in CPDD (median: 3.0) than in patients with FIPO (median: 0.3) and was strongly associated with the diagnosis (odds ratio 13.8; CI 3.4-59.8). Definite ST osteoarthritis identified CPDD with a sensitivity of 83% and a specificity of 73% with regard to FIPO. It was concluded that the presence of ST osteoarthritis is a helpful diagnostic finding for the diagnosis of CPDD in an elderly, predominantly female population with a high prevalence of FIPO. Especially in cases without radiographic cartilage or fibrocartilage calcification of the wrist, ST osteoarthritis may point to the correct diagnosis.

Aged↗

PubMed2001

The anatomy of the ligaments of the wrist and distal radioulnar joints.

The ligaments of the wrist are responsible for guiding and constraining the complex motion of the carpal bones relative to the forearm bones, the metacarpals, and contiguous carpal bones. The majority of wrist ligaments are found within the joint capsule as organized thickenings composed of parallel collagen fascicles, small caliber nerves and blood vessels, and lined on their deep surfaces by synoviocytes. The palmar radiocarpal ligament complex is composed of the radioscaphocapitate, long radiolunate, radioscapholunate and short radiolunate ligaments. The ulnocarpal ligaments include the ulnolunate, ulnotriquetral and ulnocapitate ligaments. Dorsally, the radiocarpal joint is spanned by the dorsal radiocarpal ligament. Palmar ligaments connecting the proximal and distal carpal rows include the scaphotrapeziotrapezoid, scaphocapitate, triquetrocapitate and triquetrohamate ligaments. Within each row are interosseous ligaments connecting adjacent carpal bones, each divisible into dorsal and palmar components. There are unique regions within some of the ligaments, such as a zone of fibrocartilage in the proximal regions of the scapholunate and lunotriquetral interosseous ligaments, and strong deep regions connecting the trapezoid, capitate, and hamate. The distal radioulnar joint is connected by the triangular fibrocartilage complex, composed of a fibrocartilaginous disc and the palmar and dorsal radioulnar ligaments. The ulnocarpal ligaments attach to the palmar radioulnar ligament rather than directly to the ulna, allowing increased independence between wrist and forearm motion.

Forearm↗

PubMed2004

[The anatomy of the ulnocarpal complex].

The ulnocarpal complex (triangular fibrocartilage complex; TFCC) represents an intricate system of structures which secures motion guidance, stability and pressure transmission in the ulnocarpal compartment of the wrist joint. Anatomically, this complex consists of the ulnocarpal disc (triangular disc), palmar and dorsal radioulnar ligaments, ulnolunate, ulnotriquetral and ulnocapitate ligaments, ulnocarpal meniscus homologue, ulnar recess (prestyloid recess), ulnocarpal collateral ligament and tendon sheath of the extensor carpi ulnaris. The distal radioulnar joint and the interosseous membrane of the forearm, which lie close together, also belong functionally to the ulnocarpal complex. Together with the proximal radioulnar joint, they permit rotational movements of the hand (pronation and supination). This review highlights all components of the ulnocarpal complex systematically. Distinctive characteristics involving size, as well as variations, are listed, and their functional meaning analyzed. The accumulated knowledge serves as a basis for possible interventions both at the ulnocarpal complex and the distal radioulnar joint.

Carpal Bones↗

PubMed1996

Classification and treatment of ulnar styloid nonunion.

Symptomatic nonunion of the ulnar styloid is an uncommon problem that is usually best treated by simple excision of the ulnar styloid fragment. Two types of nonunion of the ulnar styloid are described here on an anatomic basis, and their treatment differs. Type 1 is defined as a nonunion associated with a stable distal radioulnar joint. Type 2 is defined as a nonunion associated with subluxation of the distal radioulnar joint. The postoperative follow-up period for the two types ranged from 4 months to 13 years, with a mean of 5 years 2 months. Eleven type 1 wrists were treated with excision of the fragment, and all patients had satisfactory relief of pain. Nine type 2 wrists required restoration of the anatomy of the traingular fibrocartilage complex. Three of these had large fragments that were treated by open reduction and internal fixation. All three patients were completely relieved of their discomfort. Six other patients underwent excision of the fragment and repair of the triangular fibrocartilage complex to the distal ulna. This group had four excellent, one good, and one fair result. If the distal radioulnar joint is stable on presentation or if its stability is restored, then long-term relief of pain from ulnar styloid nonunion is achieved by treatment of the nonunion.

Adolescent↗