Keywords:
Trauma, Athletic injuries, Arthritides, Arthrography, MR, Musculoskeletal joint
Authors:
L. A. Mohamed1, M. Yadegarfar1, A. M. Syed2, I. Khan1, S. Naqvi1; 1Leicester/UK, 2Leicester /UK
DOI:
10.26044/essr2019/P-0106
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 25 gauge needle.
The target is the waist of the scaphoid just distal to the dorsal lip of the distal radius. (Fig.
1)
3.
The second punture is aimed at the MCJ (Fig.
2) targeting the recess between the lunate,
capitate and hamate bones.
4.
The third puncture involves the DRUJ (Fig.
3).
The target is the lower edge of the DRUJ.
This is usually done if a TFCC tear is suspected.
It helps to delineate undersurface tears.
Usually 0.5ml of Gadolinium in the DRUJ and 1-2ml in the RCJ and MCJ are sufficient to distend the joint capsule and delineate the anatomy.
The patient is then immediately taken to the MR scanner to avoid delay leading to contrast absorption.
Figures 1-3 are Fluoroscopic views demonstrating the landmarks for each puncture point.
A number of pathologies and injuries can be evaluated using this technique and these include Scapholunate Ligament (SLL) Tear (Fig.
5),
which usually occurs as a result of injury[3] and the Triangular Fibrocartilage Complex (TFCC) perforation (Fig.
7),
which can be traumatic or degenerative[4].
Other common injuries which can be evaluated using this technique are LTL tear and ulnomeniscal homologue injury.