Ligamentous injuries of the wrist are often overlooked, leading to secondary instability. Scapholunate, lunatotriquetral ligaments and Triangular fibrocartilage complex are the commonly injured ligaments. Accurate pre-operative localisation of the abnormality aids in the surgical planning. Triple injection CT wrist arthrogram was the imaging of choice to assess the ligaments tears but with the advent of MRI, the role is limited to those cases where MRI is contraindicated. The other reason would be immediate availability of the CT as a modality of investigation in certain centres....

We looked retrospectively at the MR arthrograms of the wrist performed since January 2013 till December 2015 at our hospital. We looked at the number of injections for the wrist arthrogram, clinical indication, and MR arthrogram findings. We also looked at the patient notes to see the treatment offered and the outcome. The operative findings were also reviewed in case of surgical management.

4 out of 14 pts underwent arthroscopy(28.57%) which agreed withsingle injection MR arthrogramfindings. 1 pt had open repair of TFCC. 3 out of 21 patients underwent arthroscopy (14.29%) followingdouble injection MR Arthrogram. The arthroscopic findings agreed with MR arthrogram in 2 patients. One patient had normal MR arthrogram and the arthroscopy showed grade 1 Geissler SL and LT ligament. One patient was offered arthroscopy/injection but refused as the symptoms were improving. One out of 21 patients had arthroscopic assessment(4.76%), which confirmed thetriple injection MRarthrogram findings.

The number of patient’s undergoing arthroscopic assessment has reduced from 28.57% for single injection to 4.75% for those undergoing triple injection arthrogram. This is an indirect indication of improved clinical agreement and confidence in the Arthrographic findings. The incidence of diagnosing TFCC tear is higher on the double and triple injection MR arthrograms with 4 out of 26 (15.38%) TFCC tears being undersurface tears on the multiple injection arthrogram. Single injection arthrogram did however demonstrate 9 TFCC tears but no under surface tear was diagnosed...

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