Range of movement in the wrist as a diagnostic tool in radial-sided wrist pain

Kienböck disease is diagnosed by imaging studies, and is often difficult to diagnose in its early stages. Our clinical impression is that wrist movement is more limited in Kienböck disease than when radial-sided wrist pain is caused by other conditions. The purpose of this study was to determine the use of wrist movement in differentiating between early Kienböck disease and radial-sided sprained wrist. We retrospectively reviewed 62 cases of Kienböck disease and 49 patients with radial-sided wrist sprain. Wrist movement at presentation was recorded. The two groups differed significantly in flexion and extension (p<0.001). The ability of movement of the affected wrist relative to the normal side to distinguish between the groups was excellent (AUC?=?0.96, 0.97, respectively). The ability of wrist movement measurements to differentiate between early Kienböck disease and radial-sided wrist sprain emphasises that wrist movement should be measured prior to invasive or expensive testing.     

Electron microscopy as a diagnostic tool in pathology.

As pathologists begin to examine increasing numbers of tumors under the electron microscope and the biochemistry begins to characterize molecular change associated with disease states, electron microscopy will gain wider acceptance in clinical practice. The clinician is admonished not to rely on electron microscopy as a sole diagnostic tool, but to use it as an integral part of the available diagnostic armamentarium.     

MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness

Background and purpose — The epidemiology and optimal diagnostics of wrist injuries in children are not knotwn. We describe fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.

Patients and methods — From 2004 to 2007, patients less than 18 years of age who presented at our emergency department were included in the study. 90 wrists in 89 patients underwent clinical, radiographic, and low-field MRI investigation. If plain radiographs or MRI revealed a scaphoid fracture, a supplementary CT scan was performed. Sensitivity and specificity of radiographs and CT for diagnosis of scaphoid fractures was calculated using MRI as the reference standard.

Results — 74 fractures were diagnosed in 61 of 90 wrists using MRI; 48 wrists had a scaphoid fracture, 8 had a distal radius fracture, 7 had a capitate fracture, and 3 had a triquetrum fracture. The most common combination of fractures was scaphoid and capitate. The sensitivity of radiographs for visualization of scaphoid fractures was 54% and the specificity was 100%. The sensitivity for other fractures was <50%. The sensitivity of CT for visualization of scaphoid fractures was 96% and it was between 33% and 100% for other fractures.

Interpretation — MRI showed a high incidence of fractures in children and adolescents with posttraumatic radial wrist tenderness, and it led to the diagnosis of more fractures than plain radiographs and CT. A scaphoid fracture was the most common carpal injury, followed by fracture of the capitate.     

Chronic wrist pain.

Chronic wrist pain is among the most difficult diagnostic and therapeutic challenges faced by hand surgeons. The causes are often elusive, of long duration, and not uncovered easily by routine diagnostic methods. This article outlines a systematic evaluation of the patient with chronic wrist pain to determine which of many potential conditions is the cause of the wrist pain so an effective therapeutic plan can be formulated.     

Surgeon-performed ultrasound as a diagnostic tool in appendicitis

Purpose

Diagnosing appendicitis may require adjunct studies such as computed tomography or ultrasound (US). Combining a clinical examination with surgeon-performed US (SPUS) may increase diagnostic accuracy and decrease radiation exposure and costs.

Methods

A prospective study was conducted including children with a potential diagnosis of appendicitis. A surgery resident performed a clinical examination and US to make a diagnosis. Final diagnosis of appendicitis was confirmed by operative findings and pathology. Results were compared with radiology department US (RDUS) and a large randomized trial. Analysis was performed using Fisher exact test.

Results

Fifty-four patients were evaluated and underwent SPUS. Twenty-nine patients (54%) had appendicitis. Overall accuracy was 89%, with accuracy increasing from 85% to 93% between the 2 halves of the study. Radiology department US was performed on 21 patients before surgical evaluation, yielding an accuracy of 81%. Surgeon-performed US on those 21 patients yielded an accuracy of 90%. No statistical differences were found between any groups (P > .05).

Conclusion

Accuracy of SPUS was similar to RDUS and that of a large prospective randomized trial performed by radiologists. Furthermore, when the same clinician performs the clinical examination and US, a high level of accuracy can be achieved. With this degree of accuracy, SPUS may be used as a primary diagnostic tool and computed tomography reserved for challenging cases, limiting costs, and radiation exposure.     

The incidence of dorsal radiocarpal ligament tears in patients having diagnostic wrist arthroscopy for wrist pain

PURPOSE: The goal of this study was to examine the incidence of dorsal radiocarpal ligament (DRCL) tears in patients having diagnostic arthroscopy for chronic wrist pain. METHODS: A chart review was performed of 64 patients who had diagnostic wrist arthroscopy for chronic wrist pain that was refractory to conservative measures. For each case, interosseous ligament instability/tears were graded according to the Geissler classification. Tears of the triangular fibrocartilage complex and the presence or absence of a DRCL tear were noted. RESULTS: There were 35 of 64 wrists (in 64 patients) with DRCL tears. The average duration of wrist pain prior to treatment was 20 months. Only 10 patients could recall a specific injury. Five patients had an isolated DRCL tear. A scapholunate interosseous ligament injury was identified in 13 patients, of whom 7 had a concomitant DRCL tear. A lunotriquetral interosseous ligament injury was present in 7 patients, of whom 2 had a concomitant DRCL tear. Two patients had a capitohamate ligament tear: 1 of these patients had a DRCL tear. There were 7 patients with a solitary triangular fibrocartilage complex tear: 6 of 7 were in association with a DRCL tear. One patient had a chronic ulnar styloid nonunion and a DRCL tear. Two or more lesions were present in 23 patients; DRCL tears were present in 12. CONCLUSIONS: DRCL tears are commonly seen with injuries to the primary wrist stabilizers. Recognition of this condition and further research into treatment methods are needed. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.     

Vibrotactilometry as a diagnostic tool in ulnar nerve entrapment at the elbow.

Vibrotactilometry with testing of the thresholds of the vibration sense at seven frequencies between 8-500 Hz in different intensities has been correlated with nerve conduction studies of the ulnar nerve to evaluate its diagnostic power in neuropathies at the elbow. Thirty-nine patients with entrapment symptoms were studied. Vibrotactilometry was abnormal in 33 patients (85%) and nerve conduction studies were abnormal in 19 (49%). The sensitivity of vibrotactilometry in relation to nerve conduction studies was 89%, and in relation to the patients' symptoms was 85%. We conclude that vibrotactilometry is a sensitive test that correlates well with the patients' symptoms, while nerve conduction studies are less sensitive (49%) in relation to the patients' symptoms. Vibrotactilometry in the frequency area of 8-500 Hz is recommended in the screening of ulnar nerve entrapment. Nerve conduction studies are recommended in clinically doubtful cases to localise the entrapment to the elbow region.     

Pisiform-triquetrial osteoarthritis as cause of wrist pain

Five patients with chronic and disabling pisiform area pain in the wrist are presented. Pain was due to solitary arthrosis of the pisiform-triquetrial joint. Successful treatment was excision of the pisiform bone.     

Overutilization of shoulder magnetic resonance imaging as a diagnostic screening tool in patients with chronic shoulder pain

This was a retrospective study of 101 consecutive patients (104 shoulders) with chronic, atraumatic shoulder pain who were evaluated by a fellowship-trained shoulder specialist. The patients were assessed with a complete history, physical examination, plain radiographs, Simple Shoulder Test, and visual analog scores of pain, shoulder function, and quality of life. Forty-one percent of the shoulders presented with shoulder magnetic resonance imaging (MRI). Data analysis was performed to determine the effect of pre-evaluation MRI on patient treatment and outcome. There were no statistically significant differences in age, sex, affected shoulder, insurance status, mechanism of injury, comorbid conditions, range of motion, treatment, initial outcome parameter assessments, or improvement of outcomes between the patients who had pre-evaluation MRI and those who did not. The majority of the pre-evaluation MRI scans had no impact on the outcome. Routine pre-evaluation with MRI does not appear to have a significant effect on the treatment or outcome and should not be used as a screening tool for atraumatic shoulder pain before a comprehensive clinical evaluation of the shoulder.     

An anomalous muscle mimicking a dorso-radial ganglion as a cause of radial wrist pain.

We report an abnormal muscle on the radial aspect of the wrist, which presented clinically as a ganglion and radial wrist pain. Existence of muscles in the first compartment has been accounted earlier, however its atypical presentation advocates its inclusion in the differential diagnosis of a dorso-radial ganglion and wrist pain.     

Using LIBS as a diagnostic tool in pediatrics beta-thalassemia

Lasers in Medical Science - Beta-thalassemia major is a common inherited single-gene disorder. Thalassemic patients are at risk of changes in some important trace elements. To detect alteration of...     

Use of adenosine deaminase as a diagnostic tool for tuberculous pleurisy.

BACKGROUND--A statistical audit of adenosine deaminase (ADA) in pleural effusions was undertaken. METHODS--ADA analysis, cytological and microbiological examinations, and differential cell counts were performed on 462 pleural fluid samples. RESULTS--ADA activity in tuberculous effusions was higher than in any other diagnostic group. At a level of 50 U/l the sensitivity and specificity for the identification of tuberculosis was 90% and 89%, respectively. CONCLUSIONS--ADA activity remains a useful test in the evaluation of pleural effusions.     

Disruption of the ulnolunate ligament as a cause of chronic ulnar wrist pain

Chronic ulnar wrist pain is both difficult to diagnose and difficult to treat effectively. A number of anatomic derangements have been reported as potential causes of this pain. We discuss a patient with pain on the ulnar side of the wrist and an arthroscopically diagnosed disruption of the ulnolunate ligament. This was an isolated lesion, and the patient responded well to debridement.     

Bone marrow examination as a diagnostic tool in carcinoma of the prostate

155 patients with a newly discovered carcinoma of the prostate were investigated for the presence of bone metastases. Straight X-ray (conventional X-ray) revealed such secondary in 38 cases and bone marrow examination in 20. Three patients with a normal X-ray picture nevertheless showed cancer cells on bone marrow examination. The authors consider bone marrow examination as a valuable complement to the routine invedtigation of the patients with carcinoma of the prostate.     

The ambulatory electro-encephalogram as a diagnostic tool in a children's hospital

The neurophysiology laboratory at the Red Cross War Memorial Children's Hospital provides a diagnostic electro-encephalogram (EEG) service for the hospital and surrounding community. In selected cases ambulatory EEG monitoring is undertaken. The present study is a review of the findings in 55 children thus investigated using the Oxford monitor. Indications included unexplained aberrant behaviour outbursts, erratic school performance, atypical absence episodes and the need to distinguish between real and simulated seizures in children with epilepsy. During reporting, correlations were noted between EEG appearances and the child's behaviour. Abnormalities were noted in 35 of the records. These included paroxysmal spike and wave discharge, focal cortical abnormalities and unequivocal seizure episodes. It is felt that the investigation made a significant contribution to correct diagnosis in 32 cases, and that ambulatory monitoring should be available in all laboratories which offer a diagnostic EEG service for children.