Ulnar Imaging for Arthroscopic Surgeons

Chapter

Abstract

Most of the diagnosis of ulnar-sided wrist pain relies on clinical findings supported by conventional radiology. When a particular disease is suspected, it may be useful to carry out specific radiographic projections. Ultrasound is the most useful tool for the diagnosis of tendon pathology and compressive neuropathies. Ultrasound facilitates guidance of infiltrations and interventional procedures. MDCT’s role is the diagnosis of occult fractures and three-dimensional evaluation of fractures, especially in articular fractures. MR imaging is a useful tool for the diagnosis of most intra-articular and extra-articular pathologies of the wrist. However, MR imagingstill have two major limitations, diagnosis of lesions of TFCC Palmer class 1B and carpal instability. Arthrographic sectional techniques (CT arthrography and MR arthrography) may overcome these limitations of conventional MR imaging, allowing a precise diagnosis of TFCC lesions, LT ligament injuries, and midcarpal instability.

Keywords

Magnetic Resonance Arthrography Impaction Syndrome Ulnar Variance Flexor Carpus Ulnaris Compute Tomography Arthrography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

I would like to thank my friend, Paco Piñal, whose encouragement, guidance, and support for many years have enabled me to develop an understanding of the subject.

References

  1. 1.
    Allende C, Le Viet D (2005) Extensor carpi ulnaris problems at the wrist: classification, surgical treatment and results. J Hand Surg Br 30:265–272PubMedCrossRefGoogle Scholar
  2. 2.
    Amrami KK, Moran SL, Berger RA et al (2010) Imaging the distal radioulnar joint. Hand Clin 26:467–475PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson ML, Skinner JA, Felmlee JP et al (2008) Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. J Hand Surg Am 33(7):1153–1159PubMedCrossRefGoogle Scholar
  4. 4.
    Atzei A (2010) Arthroscopic management of DRUJ instability following TFCC ulnar tears. In: Del Piñal F, Mathoulin C, Luchetti R (eds) Arthroscopic management of distal radius fractures. Springer, BerlinGoogle Scholar
  5. 5.
    Atzei A, Luchetti R (2011) Foveal TFCC tear classification and treatment. Hand Clin 27:263–272PubMedCrossRefGoogle Scholar
  6. 6.
    Bianchi S, Montet X, Martinoli C et al (2004) High-resolution sonography of compressive neuropathies of the wrist. J Clin Ultrasound 32(9):451–461PubMedCrossRefGoogle Scholar
  7. 7.
    Bille B, Harley B, Cohen H (2007) A comparison of CT arthrography of the wrist to findings during wrist arthroscopy. J Hand Surg Am 32(6):834–841PubMedCrossRefGoogle Scholar
  8. 8.
    Blum AG, Zabel JP, Kohlmann R et al (2006) Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics 26:1021–1044PubMedCrossRefGoogle Scholar
  9. 9.
    Bordalo-Rodrigues M, Amin P, Rosenberg ZS (2004) MR imaging of common entrapment neuropathies at the wrist. Magn Reson Imaging Clin N Am 12(2):265–279PubMedCrossRefGoogle Scholar
  10. 10.
    Borelli P, Luchetti R (2010) Treatment of the associated ulnar-sided problems. In: Del Piñal F, Mathoulin C, Luchetti R (eds) Arthroscopic management of distal radius fractures. Springer, BerlinGoogle Scholar
  11. 11.
    Buck FM, Gheno R, Nico MAC et al (2009) Ulnomeniscal homologue of the wrist: correlation of anatomic and MR imaging findings. Radiology 253(3):771–779PubMedCrossRefGoogle Scholar
  12. 12.
    Budoff JE, Kraushaar BS, Ayala G (2005) Flexor carpi ulnaris tendinopathy. J Hand Surg Am 30(1):125–129PubMedCrossRefGoogle Scholar
  13. 13.
    Burns J, Tanaka T, Ueno T et al (2011) Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging. Radiographics 31:63–78PubMedCrossRefGoogle Scholar
  14. 14.
    Buterbaugh GA, Brown TR, Horn PC (1998) Ulnar-sided wrist pain in athletes. Clin Sports Med 17(3):567–583PubMedCrossRefGoogle Scholar
  15. 15.
    Cerezal L, Del Piñal F, Abascal F et al (2002) Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 22:105–121PubMedGoogle Scholar
  16. 16.
    Cerezal L, Del Piñal F, Abascal F (2004) MR imaging findings in ulnar-sided wrist impaction syndromes. Magn Reson Imaging Clin N Am 12:281–299PubMedCrossRefGoogle Scholar
  17. 17.
    Cerezal L, Abascal F, García-Valtuille R, Del Piñal F (2005) Wrist MR arthrography: how, why, when. Radiol Clin North Am 43:709–731PubMedCrossRefGoogle Scholar
  18. 18.
    Coggins CA (2006) Imaging of ulnar-sided wrist pain. Clin Sports Med 25:505–526PubMedCrossRefGoogle Scholar
  19. 19.
    De Filippo M, Pogliacomi F, Bertellini A et al (2010) MDCT arthrography of the wrist: diagnostic accuracy and indications. Eur J Radiol 74(1):221–225PubMedCrossRefGoogle Scholar
  20. 20.
    del Piñal F (2009) The 1B constellation. Presented at the FESSH Congress in Poznan, Poland. Book of abstractsGoogle Scholar
  21. 21.
    Fontés D (2010) Lunotriquetral and extrinsic ligaments lesions associated with distal radius fractures. In: Del Piñal F, Mathoulin C, Luchetti R (eds) Arthroscopic management of distal radius fractures. Springer, BerlinGoogle Scholar
  22. 22.
    Friedman SL, Palmer AK (1991) The ulnar impaction syndrome. Hand Clin 7(2):295–310PubMedGoogle Scholar
  23. 23.
    Garcia-Elias M, Geissler WB (2005) Carpal instability. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW (eds) Green’s operative hand surgery. Elsevier Churchill Livingstone, PhiladelphiaGoogle Scholar
  24. 24.
    Goldfarb CA, Yin Y, Gilula LA, et al (2001) Wrist fractures: what the clinician wants to know. Radiology 219(1):1–18Google Scholar
  25. 25.
    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(2):419–422PubMedGoogle Scholar
  26. 26.
    Kaewlai R, Avery LL, Asrani AV et al (2008) Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics 28:1771–1784PubMedCrossRefGoogle Scholar
  27. 27.
    Malik AM, Schweitzer ME, Culp RW et al (1999) MR imaging of the type II lunate bone: frequency, extent, and associated findings. AJR Am J Roentgenol 173:335–338PubMedGoogle Scholar
  28. 28.
    MacLennan AJ, Nemechek NM, Waitayawinyu T, Trumble TE (2008) Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation. J Hand Surg Am 33(1):59–64PubMedCrossRefGoogle Scholar
  29. 29.
    Moritomo H, Masatomi T, Murase T et al (2010) Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism. J Hand Surg 35(12):1955–1963CrossRefGoogle Scholar
  30. 30.
    Moser T, Dosch JC, Moussaoui A et al (2008) Multidetector CT arthrography of the wrist joint: how to do it. Radiographics 28(3):787–800PubMedCrossRefGoogle Scholar
  31. 31.
    Nakamura T (2010) Radial side tear of the triangular fibrocartilage complex. In: Del Piñal F, Mathoulin C, Luchetti R (eds) Arthroscopic management of distal radius fractures. Springer, BerlinGoogle Scholar
  32. 32.
    Nishikawa S, Toh S, Miura H, Arai K (2002) The carpal detachment injury of the triangular fibrocartilage complex. J Hand Surg Br 27(1):86–89PubMedGoogle Scholar
  33. 33.
    Omlor G, Jung M, Grieser T, Ludwig K (2008) Depiction of the triangular fibro-cartilage in patients with ulnar-sided wrist pain: comparison of direct multi-slice CT arthrography and direct MR arthrography. Eur Radiol 19(1):147–151PubMedCrossRefGoogle Scholar
  34. 34.
    Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14:594–606PubMedCrossRefGoogle Scholar
  35. 35.
    Papp S (2007) Carpal bone fractures. Orthop Clin North Am 38(2):251–260PubMedCrossRefGoogle Scholar
  36. 36.
    Protopsaltis TS, Ruch DS (2010) Triangular fibrocartilage complex tears associated with symptomatic ulnar styloid nonunions. J Hand Surg 35(8):1251–1255CrossRefGoogle Scholar
  37. 37.
    Rüegger C, Schmid M, Pfirrmann C et al (2007) Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint. AJR Am J Roentgenol 188:187–192PubMedCrossRefGoogle Scholar
  38. 38.
    Schmid MR, Schertler T, Pfirrmann CW et al (2005) Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging. Radiology 237(3):1008–1013PubMedCrossRefGoogle Scholar
  39. 39.
    Slutsky D (2011) Arthroscopic evaluation of the foveal attachment of the triangular fibrocartilage. Hand Clin 27:255–261PubMedCrossRefGoogle Scholar
  40. 40.
    Tagliafico A, Rubino M, Autuori A et al (2007) Wrist and hand ultrasound. Semin Musculoskelet Radiol 11(2):95–104PubMedCrossRefGoogle Scholar
  41. 41.
    Tanaka T, Ogino S, Yoshioka H (2008) Ligamentous injuries of the wrist. Semin Musculoskelet Radiol 12:359–378PubMedCrossRefGoogle Scholar
  42. 42.
    Theumann N, Etechami G, Duvoisin B et al (2006) Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations. Radiology 238:950–957PubMedCrossRefGoogle Scholar
  43. 43.
    Thurston AJ, Stanley JK (2000) Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy 16(5):540–544PubMedCrossRefGoogle Scholar
  44. 44.
    Timins ME (1999) Osseous anatomic variants of the wrist: findings on MR imaging. AJR Am J Roentgenol 173:339–344PubMedGoogle Scholar
  45. 45.
    Toms A, Chojnowski A, Cahir J (2011) Midcarpal instability: a radiological perspective. Skeletal Radiol 40:533–541PubMedCrossRefGoogle Scholar
  46. 46.
    Topper SM, Wood MB, Ruby LK (1997) Ulnar styloid impaction syndrome. J Hand Surg Am 22:699–704PubMedCrossRefGoogle Scholar
  47. 47.
    Trumble T (2011) Radial side (1D) tears. Hand Clin 27:243–254PubMedCrossRefGoogle Scholar
  48. 48.
    Watanabe A, Souza F, Vezeridis PS et al (2010) Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 39:837–857PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyDiagnóstico Médico Cantabria (DMC)SantanderSpain

Personalised recommendations