Bilateral Arthrography of the Wrist Joint
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Wrist pain
Arthrogram
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Physical examination is critical to formation of a differential diagnosis in patients with ulnar-sided wrist pain. Although the specificity and sensitivity of some of those tests have been reported...
Wrist pain
Ulnar artery
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Twenty-seven patients with complaints of wrist and/or hand pain were evaluated using a quantitative technique of dynamic (blood flow analysis) and static bone scan. The patients were divided in two groups according to their clinical history. Group A included 13 patients with a history of trauma. Seven patients had scaphoid fracture and 6 of them were scanned to determine non-union and/or avascular necrosis of the joint. One patient was scanned to determine the viability of a graft for non-union fracture. In all cases the scan gave a correct diagnosis as confirmed by later x-ray changes. Six patients in this group had negative x-rays. The scan demonstrated 4 cases of occult fractures, 4 had early Kienbock's Disease (KD) and 1 a soft tissue tumor. Group B included 14 patients with no known history of trauma. Nine had positive x-rays including 3 with KD that were scanned to determine their viability for surgical replacement of the lunate. The scan could distinguish between isolated involvement of the lunate and secondary degenerative changes of the surrounding carpal bones and radiocarpal joint. Two patients with tumor were correctly diagnosed by the scan, one as benign and one malignant. Four other patients with nonspecific changes onmore » x-ray showed early arthritis (3 cases) and a cyst of the triquetrum ( 1 case) on the bone scan. Four patients in Group B had negative x-rays and the scan showed degenerative changes (3 cases) and an occult fracture of the hamate (1 case). The use of dynamic and static bone scanning appears to be a very valuable technique in the evaluation of patients with wrist and hand pain.« less
Avascular Necrosis
Carpal bones
Occult
Wrist pain
Lunate bone
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Arthrograms were performed on patients with rheumatoid arthritis of the wrist. Fifty cadavera and seven normal patients served as controls. Sixty arthrograms on thirty-eight patients with rheumatoid arthritis were studied. The abnormalities demonstrated consisted of corrugated pattern of the synovial cavity (90 per cent), communication between radiocarpal and inferior radio-ulnar joint (70 per cent), between radiocarpal and mid-carpal joints (70 per cent), and between the wrist joint and the extensor tendon sheaths (21 per cent). One abnormality was suggestive of a diagnosis of rheumatoid arthritis and more than one was considered characteristic of the disease in the wrist joint. The abnormalities were present even before plain roentgenograms showed erosive changes. The findings in the fifteen wrists operated on correlated well with the plain roentgenographic and arthrographic findings. The interosseous ligaments and articular discs were often destroyed as early on six months after the onset of disease. The soft-tissue involvement is an important cause of volar dislocation of the wrist and dorsal subluxation of ulna and tendon rupture. The knowledge gained by arthrography has contributed evidence for early synovectomy of the wrist joint in rheumatoid arthritis.
Subluxation
Synovectomy
Carpal Joint
Carpal bones
Wrist pain
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Subacromial pain syndrome is a common musculoskeletal shoulder problem. The accuracy of clinical tests is low and techniques such as ultrasound and magnetic resonance imaging have been added to set up a diagnosis. Previous researchers have usually only examined the symptomatic shoulder. However, there might be similar findings in the asymptomatic shoulder.The aim of the present study was to investigate the prevalence of structural abnormalities of both shoulders in patients with clinically diagnosed unilateral subacromial pain syndrome using diagnostic ultrasound.Bilateral ultrasound examinations were performed in 115 consecutive patients, 54 men and 61 women. The patients were recruited from primary care centers in the area of Stockholm, Sweden.Abnormal ultrasound findings were found in both shoulders and increased with age (p = .0004). Bursitis was the most common ultrasound finding and significantly more prevalent in the symptomatic shoulder compared to the asymptomatic shoulder (90%:74%; p = .0021), though 73% of the bursitis were bilateral. Supraspinatus is the most vulnerable tendon of the rotator cuff in both shoulders. In terms of partial-thickness tears and tendinosis, the tendon was affected more commonly in the symptomatic shoulder compared to the asymptomatic shoulder (30%:14%: 14%; p = .0026) and (24%:10%; p = .0054), respectively, but for calcification no significant difference between the shoulders was found (18%:12%; 0.1988).Ultrasound detected shoulder abnormalities were present in both symptomatic and asymptomatic shoulders. Bursitis and partial-thickness tears were more common in the affected shoulder when compared to the unaffected shoulder. Ultrasound as well as clinical examination findings and patient´s history should be taken into consideration when diagnosing patients with subacromial pain syndrome.
Subacromial impingement
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Occult
Carpal bones
Wrist pain
Scaphoid bone
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Wrist Arthroscopy
Wrist pain
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Objective To introduce the clinical characteristics and management of intraosseous ganglion of wrist. Methods Eleven cases of carpal bone cystic lesions were treated from June 1993 to March 2002. All of them were proved to be intraosseous ganglion. The symptoms and imaging characteristics were summarized retrospectively. The relationships between the age, gender and some other factors of the patients with the incidence of the disease were analysed. All of the patients were followed up from 3 to 62 months after operation. Results Almost all of the patients were of young and middle aged people. There were 3 males and 8 females. The lesion most likely occurred in the dominant hand(72.7%). The main symptom of wrist intraosseous ganglion was pain, the average duration of symptoms was 2-84 months. X-rays showed a translucent area with a thin sclerotic margin within the carpal bone. CT scanning and MRI demonstrated it was liquid in content. After operation, 8 patients obtained an excellent result with no pain and normal function, 2 good with mild discomfort and one poor with no improvement. Conclusion Although intraosseous ganglion of wrist is a rare disease, it has some basic clinical characteristics. It is diagnosed according to its symptoms and imaging manifestations, and is confirmed by the operative findings and pathologic examination. Surgical treatment usually achieves satisfactory results.
Ganglion cyst
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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.
Scapholunate ligament
Abnormality
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Bilateral arthrotomography was performed in 50 consecutive patients with unilateral symptoms of disc displacement to evaluate the frequency of temporomandibular joint disc displacement in asymptomatic joints. Using well-defined clinical criteria, there were no false-positive findings of either reducing or non-reducing discs. On the other hand, a risk of false-negative diagnosis of non-reducing disc was apparent. Sixty per cent of the patients had a non-reducing displaced disc in the asymptomatic joint. Most of these patients could recall a previous spell of discomfort from this joint. Severe or moderate deformation had taken place in non-reducing discs, while reducing discs were normal in shape or had, at most, a thickening of the posterior band. The duration of symptoms was significantly correlated with the degree of deformation in the symptomatic joints (P less than 0.01). Perforation was statistically, significantly correlated with disc deformation and, in symptomatic joints, hard tissue changes. Fifty-seven per cent of the asymptomatic joints with displaced discs developed pain following the onset of symptoms from the contralateral side, most within 2 years. Less than half of them were free of pain at the end of the 5 year follow-up period. In view of this tendency for an asymptomatic joint with a displaced disc to subsequently develop pain refractory to treatment, such a joint must be considered a weakened link in the craniomandibular system, vulnerable to changes in mandibular function such as, for instance, displacement of the disc on the contralateral side.
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Fifty consecutive patients who had a history and clinical findings consistent with internal derangement of the wrist were prospectively entered into a study to compare the findings of triple-injection arthrography with those of arthroscopy of the wrist with use of three portals. Twenty-six patients were men, and twenty-four were women. They had an average age of thirty-six years (range, eighteen to seventy years). The average duration of symptoms in the wrist was eight months (range, one to twenty-four months). The arthrograms of the wrist, which included cineradiographs, were all made and evaluated by the same radiologist. The arthroscopic evaluation of the wrists was performed by two hand surgeons who had previous knowledge of the arthrographic findings.The abnormal findings included in this study were limited to those that should be detectable with both arthrography and arthroscopy. These were full-thickness tears of the scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage. The findings of arthrography were normal in eighteen wrists, demonstrated a single lesion in twenty-one, and demonstrated multiple lesions in eleven. Twelve wrists were noted to have a tear of the scapholunate ligament; fifteen, a tear of the lunotriquetral ligament; and eighteen, a tear of the triangular fibrocartilage. The arthroscopic findings were normal in six wrists, demonstrated a single lesion in twenty-five, and demonstrated multiple lesions in nineteen. Twenty-two wrists were noted to have a tear of the scapholunate ligament; fifteen, a tear of the lunotriquetral ligament; and thirty, a tear of the triangular fibrocartilage. When compared with arthroscopy of the wrist, the sensitivity, specificity, and accuracy of triple-injection cinearthrography in detecting tears of the scapholunate ligament, lunotriquetral ligament, and triangular fibrocartilage, as a group, were 56, 83, and 60 per cent. Although arthrography of the wrist is a well accepted diagnostic modality in the evaluation of pain in the wrist, this study suggests that normal arthrographic findings do not necessarily rule out the possibility of internal derangement of the wrist.
Scapholunate ligament
Wrist Arthroscopy
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