Learning objectives
Wrist arthrography,
particularly when coupled with MR evaluation is an invaluable tool in the evaluation of ligamentous tears,
allowing for the precise delineation of injury to the wrist [1].
Several techniques for performing this procedure exist in the current literature.
These include single,
double and triple injection techniques [1].
The purpose of this poster is to highlight the triple injection technique [1].
Background
Triple compartment arthrography is considered the most specific technique for evaluating ligamentous injuries of the wrist.
MR arthrogram can also guide to differentiate between traumatic and degenrate tears.
Levinsohn et al.,
(1991) highlighted a significantly improved diagnostic yield following the evaluation of 300 patients who had the triple compartment injection technique [2]. This involved a separate injection into all three wrist compartments,
with the addition of the mid-carpal joint (MCJ) and distal radio-ulnar joint (DRUJ) injections to the standard radio-carpal joint (RCJ) injection.
We evaluated...
Imaging findings OR Procedure Details
Procedure Details:
1.
The patient is prepared for the procedure.
This involves positioning,
cleaning the injection site and draping.
- Patient is positioned in the ‘superman’ position- lying prone with the arm flexed at the shoulder level and wrist flat on the bed.
- Wrist is positioned horizontally directly under the fluoroscopy.
The injection site is marked with a surgical pen.
- Dorsal aspect of the wrist is then cleaned and draped.
Local anaesthetic is used for analgesia.
2.
First puncture is made with a...
Conclusion
We describe the triple compartment wrist MR arthrogram technique and the commonly evaluated and diagnosed ligament injuries [1].
Arthrographic assessment of the wrist can be done using both CT and MR evaluation.
The landmarks described and knowledge of anatomy helps perform the procedure smoothly.
References
1.
Moser T.,
Dosch J-C.,
Moussaoui A.,
Buy X.,
Gangi A.,
Dietemann J-L.,
(2009).
Multidetector CT Arthrography of the Wrist Joint: How to Do It.
RSNA.
Vol.
28 (No.3)
2.
Levinsohn E M.,
Rosen I D.,
Palmer A K.,
(1991).
Wrist arthrography: value of the three-compartment injection method.
RSNA.
Vol.
179 (No.
1)
3.Andersson,
J.
(2017).
Treatment of scapholunate ligament injury.EFORT Open Reviews,
[online] 2(9),
pp.382-393.
Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644424/ [Accessed 14 May 2019].
4.Chan,
J.,
Teunis,
T.
and Ring,
D.
(2014).
Prevalence of Triangular Fibrocartilage...