Development of a Protocol for SPECT/CT in the Assessment of Wrist Disorders
8
Citation
20
Reference
10
Related Paper
Citation Trend
Abstract:
Background Single-photon emission computed tomography and computed tomography (SPECT/CT) is a hybrid diagnostic imaging modality that allows clinicians to integrate their diagnostic evaluations and deliver a definitive diagnosis in musculoskeletal disorders. Specifically, in identification of osseous pathology, the conventional bone scan delivers greater specificity compared with magnetic resonance imaging (MRI). However, use of SPECT/CT enhances the sensitivity and specificity. Use of this modality denotes the possibility to specify the lesion more accurately and precisely while grading the activity according to osseous structural changes. Purpose This study aimed to evaluate the clinical utility of SPECT/CT in the diagnoses and management of osseous wrist disorders. The objectives were to examine the value of SPECT/CT in the diagnosis of osseous-related wrist pain and whether the findings altered management. Patients and Methods A retrospective cohort study of 20 patients with such wrist pain was conducted. SPECT/CT was used in the diagnostic process for these patients. Results Following SPECT/CT imaging, the common final diagnoses were osteoarthritis (10; 50%) and avascular necrosis (5; 25%). Less common diagnoses included ulnar carpal impact syndrome, infection, malunion, complex regional pain syndrome, and carpal boss. Some presented with multiple pathologies. SPECT/CT changed the final diagnosis in 11 cases, resulting in nonoperative treatment (7; 63%) or surgery (4; 37%). Conclusion Findings from this study and the literature demonstrate the clinical utility of SPECT/CT in the assessment of osseous-related wrist disorders. We present an algorithm for the assessment of wrist pain with osseous pathology. This commences with clinical assessment and plane radiographs (first-line investigation). Some cases will require a second-line investigation (ultrasound, CT, and/or MRI). If the diagnosis remains unclear, SPECT/CT is recommended as a third-line investigation.Keywords:
Wrist pain
Avascular Necrosis
Wrist pain
Cite
Citations (27)
Wrist pain
Wrist Arthroscopy
Cite
Citations (3)
Wrist pain
Arthrogram
Cite
Citations (0)
Trigger wrist is a rare condition first described by Marti in 1960, and various causes have been reported. The condition mostly occurs with finger flexion and extension, and rarely with flexion and extension of the wrist itself. Avascular necrosis of the capitate is also a rare condition, first described by Jönsson in 1942. While some reports of this condition have been published, little is known about its etiology. Therefore, no established treatment exists. We report a case of trigger wrist caused by avascular necrosis of the capitate. A 16-year-old right-handed male who was a high school handball player was referred to our department from a nearby hospital 5 months after the onset of pain in the dorsal aspect of the right wrist, with an unknown cause. At the previous hospital, imaging findings led to a diagnosis of avascular necrosis of the capitate, and conservative treatment with a wrist brace did not improve the pain. At the initial visit to our department, the patient was noted to have a painful trigger wrist that was brought on by wrist flexion and extension. Preoperative imaging findings led to a diagnosis of trigger wrist caused by capitolunate instability secondary to avascular necrosis of the capitate. We performed a partial excision of the proximal capitate with tendon ball interposition. Two years after surgery, the patient’s clinical outcome was favorable, with no recurrence of wrist pain or triggering. Both trigger wrist and avascular necrosis of the capitate are rare disorders. When a patient presents with painful triggering at the wrist, surgeons must bear in mind that avascular necrosis of the capitate may result in this phenomenon. We recommend partial excision of the proximal capitate with tendon ball interposition for the treatment of this lesion.
Avascular Necrosis
Wrist pain
Cite
Citations (9)
Wrist pain is a common presenting complaint in patients both for the hand specialist and the primary care physician. Knowledge of wrist anatomy and a thorough and systematic wrist examination remain the mainstays of evaluation. Radiologic as well as arthroscopic technology and techniques continue to evolve and provide useful adjuncts to wrist evaluation that expand our diagnostic and therapeutic capabilities.
Wrist pain
Cite
Citations (2)
Wrist pain
Wrist injury
Modalities
Cite
Citations (1)
MRI examination can clearly reflect the contents of the wrist contour and position of triangular fibrocartilage complex(TFCC),articular cartilage,carpal interosseous ligament,synovial fluid,bone marrow changes and multi-level bone structural changes of joint area.In this literature,MR imaging examination in the wrist pain was reviewed,introducing commonly examination methods of the wrist,MR imaging findings of common diseases which result in wrist pain and a number of new imaging methodologies.
Wrist pain
Carpal bones
Fibrocartilage
Cite
Citations (0)
Wrist pain
Modality (human–computer interaction)
Cite
Citations (3)
Numerous radiographic procedures are now available to help determine the cause of wrist pain. This paper presents a wrist-pain algorithm that defines the relative roles of various radiographic techniques in the evaluation of patients with wrist pain. Practical application of the algorithm is demonstrated through illustrative cases.
Wrist pain
Cite
Citations (9)