X-rays - Arthrography

Indications for carpal arthrography are the scapholunate and lunotriquetral dissociations, lesions of the foveal lamina of the TFCC and initial stages of chondropathy.

The normal wrist consists of three separate compartments: distal radioulnar joint (DRUJ), radiocarpal compartment (RCJ) and midcarpal compartment (MCJ). There is no intercompartmental communication if the separating joint structures (SL and LT ligaments and TFCC) are intact. In contrast, intercompartmental transition of the contrast medium into the neighbored compartment occurs during arthrography in the case of perforating lesions.

Three steps are important in arthrography of the wrist:

• Arthrography should be performed under fluoroscopic control in order to detect possible contrast agent passage between compartments "online".

• A puncture sequence from midcarpal (1st injection with 2-4 ml) via the distal radioulnar joint (2nd injection with 0.6-0.8 ml) towards radioscaphoidal (3rd injection of 2-4 ml) has proved to be effective. For reasons of the joint anatomy, the midcarpal puncture is performed directly at the joint space of the lunate/triquetrum/capitate/hamate, the puncture of the distal radioulnar joint at the radial edge of the ulnar head and the radioscaphoidal puncture at the proximal scaphoid edge.

• Conventional arthrography should always be combined with high-resolution cross-sectional procedures (CT or MRI) to assess the third spatial plane. These can be used to differentiate between dorsal and palmar ligament lesions, and to acquire oblique reconstructions according to the anatomical course of the ligaments.

Tags: Hand, Arthrography, Wrist, X-rays