Abstract
Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienböck’s disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain.
Similar content being viewed by others
References
Berna-Serna JD, Martinez F, Reus M, Alonso J, Domenech-Ratto G (2006) Wrist arthrography: a simple method. Eur Radiol 16:469–472
Schmitt R, Froehner S, Coblenz G, Christopoulos G (2006) Carpal instability. Eur Radiol DOI 10.1007/s00330-006-0161-1
Golimbu CN, Firooznia H, Melone CP Jr, Rafii M, Weinreb J, Leber C (1989) Tears of the triangular fibrocartilage of the wrist: MR imaging. Radiology 173:731–733
Saupe N, Prussmann KP, Luechinger R, Bosiger P, Marincek B, Weishaupt D (2005) MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging—preliminary experience. Radiology 234:256–264
Scheck RJ, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K (1999) The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging 9:468–474
Zanetti M, Bram J, Hodler J (1997) Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging 7:590–594
Linscheid RL, Dobyns JH, Beabout JW, Bryan RS (2002) Traumatic instability of the wrist: diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 84-A:142
Zanetti M, Hodler J, Gilula LA (1998) Assessment of dorsal or ventral intercalated segmental instability configurations of the wrist: reliability of sagittal MR images. Radiology 206:339–345
Haims AH, Schweitzer ME, Morrison WB et al (2003) Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging. Radiology 227:701–707
Steinbach LS, Palmer WE, Schweitzer ME (2002) Special focus session. MR arthrography. Radiographics 22:1223–1246
Bergin D, Schweitzer ME (2003) Indirect magnetic resonance arthrography. Skeletal Radiol 32:551–558
Gold GE, Fuller SE, Hargreaves BA, Stevens KJ, Beaulieu CF (2005) Driven equilibrium magnetic resonance imaging of articular cartilage: initial clinical experience. J Magn Reson Imaging 21:476–481
Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C (2004) Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. AJR Am J Roentgenol 183:343–351
Gold GE, Suh B, Sawyer-Glover A, Beaulieu C (2004) Musculoskeletal MRI at 3.0 T: initial clinical experience. AJR Am J Roentgenol 183:1479–1486
Link TM, Sell CA, Masi JN et al (2006) 3.0 vs 1.5 T MRI in the detection of focal cartilage pathology-ROC analysis in an experimental model. Osteoarthritis Cartilage 14:63–70
Zlatkin MB, Chao PC, Osterman AL, Schnall MD, Dalinka MK, Kressel HY (1989) Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology 173:723–729
Johnstone DJ, Thorogood S, Smith WH, Scott TD (1997) A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg [Br] 22:714–718
Lester B, Halbrecht J, Levy IM, Gaudinez R (1995) “Press test” for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 35:41–45
Shionova K, Nakamura R, Imaeda T, Makino N (1998) Arthrography is superior to magnetic resonance imaging for diagnosing injuries of the triangular fibrocartilage. J Hand Surg 23B:402–405
Scheck RJ, Kubitzek C, Hierner R et al (1997) The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy. Skeletal Radiol 26:263–271
Schmitt R, Christopoulos G, Meier R et al (2003) [Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients]. Rofo 175:911–919
Braun H, Kenn W, Schneider S, Graf M, Sandstede J, Hahn D (2003) [Direct MR arthrography of the wrist- value in detecting complete and partial defects of intrinsic ligaments and the TFCC in comparison with arthroscopy]. Rofo 175:1515–1524
Haims AH, Schweitzer ME, Morrison WB et al (2002) Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. AJR Am J Roentgenol 178:419–422
Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg 14A:594–606
Zanetti M, Linkous MD, Gilula LA, Hodler J (2000) Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists. Radiology 216:840–845
Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L (1997) MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR 168:1513–1518
Trumble TE, Gilbert M, Vedder N (1997) Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg 22A:57–65
Benjamin M, Evans EJ, Pemberton DJ (1990) Histological studies on the triangular fibrocartilage complex of the wrist. J Anat 172:59–67
Totterman SM, Miller RJ, McCance SE, Meyers SP (1996) Lesions of the triangular fibrocartilage complex: MR findings with a three-dimensional gradient-recalled-echo sequence. Radiology 199:227–232
Ruegger C, Schmid M, Pfirrmann CW, Nagy L, Gilula LA, Zanetti M (2007) Peripheral triangular fibrocartilage tears: depiction with distal radioulnar joint MR arthrography. AJR Am J Roentgenol (in press)
Lichtmann D, Alexander A (1996) The wrist and its disorders, 2 edn. WB Saunders, Philadelphia
Berger RA (2001) The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res 383:32–40
Viegas SF, Ballantyne G (1987) Attritional lesions of the wrist joint. J Hand Surg [Am] 12:1025–1029
Linkous MD, Pierce SD, Gilula LA (2000) Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics. Radiology 216:846–850
Allende C, Le Viet D (2005) Extensor carpi ulnaris problems at the wrist—classification, surgical treatment and results. J Hand Surg [Br] 30:265–272
Glajchen N, Schweitzer M (1996) MRI features in de Quervain’s tenosynovitis of the wrist. Skeletal Radiol 25:63–65
Singh AK, Davis TR, Dawson JS, Oni JA, Downing ND (2004) Gadolinium enhanced MR assessment of proximal fragment vascularity in nonunions after scaphoid fracture: does it predict the outcome of reconstructive surgery? J Hand Surg [Br] 29:444–448
Perlik PC, Guilford WB (1991) Magnetic resonance imaging to assess vascularity of scaphoid nonunions. J Hand Surg [Am] 16:479–484
Trumble TE (1990) Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg [Am] 15:557–564
Cerezal L, Abascal F, Canga A, Garcia-Valtuille R, Bustamante M, del Pinal F (2000) Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR Am J Roentgenol 174:141–149
Dawson JS, Martel AL, Davis TR (2001) Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium. J Bone Joint Surg Br 83:809–814
Munk PL, Lee MJ, Janzen DL et al (1998) Gadolinium-enhanced dynamic MRI of the fractured carpal scaphoid: preliminary results. Australas Radiol 42:10–15
Imaeda T, Nakamura R, Shionoya K, Makino N (1996) Ulnar impaction syndrome: MR imaging findings. Radiology 201:495–500
Schmitt R, Christopoulos G, Kalb K et al (2005) [Differential diagnosis of the signal-compromised lunate in MRI]. Rofo 177:358–366
Boks SS, Vroegindeweij D, Koes BW, Hunink MG, Bierma-Zeinstra SM (2006) Follow-up of occult bone lesions detected at mr imaging: systematic review. Radiology 238:853–862
Breitenseher MJ, Metz VM, Gilula LA et al (1997) Radiographically occult scaphoid fractures: value of MR imaging in detection. Radiology 203:245–250
Nagy L (2005) Salvage of post-traumatic arthritis following distal radius fracture. Hand Clin 21:489–498
Cohen MS, Kozin SH (2001) Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg [Am] 26:94–104
Tomaino MM, Miller RJ, Cole I, Burton RI (1994) Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg [Am] 19:134–142
Wyrick JD, Stern PJ, Kiefhaber TR (1995) Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg [Am] 20:965–970
Watson HK, Ballet FL (1984) The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg [Am] 9:358–365
Watson HK, Goodman ML, Johnson TR (1981) Limited wrist arthrodesis. Part II: Intercarpal and radiocarpal combinations. J Hand Surg [Am] 6:223–233
Bordalo-Rodrigues M, Schweitzer M, Bergin D, Culp R, Barakat MS (2005) Lunate chondromalacia: evaluation of routine MRI sequences. AJR Am J Roentgenol 184:1464–1469
Haims AH, Moore AE, Schweitzer ME et al (2004) MRI in the diagnosis of cartilage injury in the wrist. AJR Am J Roentgenol 182:1267–1270
Pfirrmann CW, Theumann NH, Chung CB, Trudell DJ, Resnick D (2002) The hamatolunate facet: characterization and association with cartilage lesions-magnetic resonance arthrography and anatomic correlation in cadaveric wrists. Skeletal Radiol 31:451–456
Peterfy CG, van Dijke CF, Lu Y et al (1995) Quantification of the volume of articular cartilage in the metacarpophalangeal joints of the hand: accuracy and precision of three-dimensional MR imaging. AJR Am J Roentgenol 165:371–375
Hargreaves BA, Gold GE, Beaulieu CF, Vasanawala SS, Nishimura DG, Pauly JM (2003) Comparison of new sequences for high-resolution cartilage imaging. Magn Reson Med 49:700–709
Dunn TC, Lu Y, Jin H, Ries MD, Majumdar S (2004) T2 relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology 232:592–598
Fischer E (1988) [Piso-triquetral arthrosis and the so-called pisiform secundarium]. Radiologe 28:338–344
Theumann NH, Pfirrmann CW, Chung CB, Antonio GE, Trudell DJ, Resnick D (2002) Pisotriquetral joint: assessment with MR imaging and MR arthrography. Radiology 222:763–770
Gunther SF (1985) Dorsal wrist pain and the occult scapholunate ganglion. J Hand Surg [Am] 10:697–703
Cardinal E, Buckwalter KA, Capello WN, Duval N (1996) US of the snapping iliopsoas tendon. Radiology 198:521–522
el-Noueam KI, Schweitzer ME, Blasbalg R et al (1999) Is a subset of wrist ganglia the sequela of internal derangements of the wrist joint? MR imaging findings. Radiology 212:537–540
Conway WF, Destouet JM, Gilula LA, Bellinghausen HW, Weeks PM (1985) The carpal boss: an overview of radiographic evaluation. Radiology 156:29–31
Hobby JL, Tom BD, Bearcroft PW, Dixon AK (2001) Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol 56:50–57
Pederzini L, Luchetti R, Soragni O et al (1992) Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging. Arthroscopy 8:191–197
Schweitzer ME, Brahme SK, Hodler J et al (1992) Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography. Radiology 182:205–211
Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack RR Jr (1997) The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg 79A:1675–1684
Totterman SM, Miller R, Wasserman B, Blebea JS, Rubens DJ (1993) Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 160:117–123
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zanetti, M., Saupe, N. & Nagy, L. Role of MR imaging in chronic wrist pain. Eur Radiol 17, 927–938 (2007). https://doi.org/10.1007/s00330-006-0365-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-006-0365-4