Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography

The use of standard lateral roentgenography for diagnosing distal radioulnar joint (DRUJ) subluxation and dislocation was investigated. Using a wrist support, bilateral standard lateral roentgenograms of the wrist were obtained in 42 patients with normal wrists and in 56 patients with a unilateral wrist injury. In normal wrists the difference between the radioulnar distance in the right and the left wrist did not exceed 4 mm when the difference in the pisoscaphoid distance was less than 3 mm. Of the 36 patients with wrist injury whose difference in pisoscaphoid distance was less than 3 mm, 15 had a radioulnar distance of 5 mm or more, and computed tomography (CT) confirmed DRUJ dislocation in 14. Concordance between lateral roentgenograms and CT was present in 33 of 36 patients (92%). These results demonstrate the value of a standardized technique for bilateral lateral roentgenography in diagnosing DRUJ subluxation and dislocation.     

Cervical facet joint arthrography

We describe a technique for cervical facet joint arthrography; a posterior approach is used. The patient is positioned prone, the neck flexed maximally, and the head turned 60-90 degrees opposite to the side of injection. The x-ray tube is angled cephalad in order to obtain a true tangent to the facet joint. The needle is inserted using fluoroscopic control in a direction parallel to the x-ray beam. Before the therapeutic infiltration, the intraarticular position of the needle is confirmed by injecting 0.3 ml of contrast medium.     

Cervical analgesic facet joint arthrography

We report on our experience with cervical analgesic facet joint arthrography in 11 patients (30 joints), of whom nine had previous spinal surgery. In this type of patient we have found the procedure to be a diagnostic test as well as a preoperative guide to the neurosurgeon, but not a permanent therapy.     

Ultrasonographic evaluation of degenerative changes in the distal radioulnar joint: correlation of findings with gross anatomy and MR arthrography in cadavers

Objective

To determine the accuracy of ultrasonography (US) in the evaluation of degenerative changes in the distal radioulnar joint (DRUJ).

Methods and materials

Ten cadaveric specimens were obtained. US evaluation of cartilage degeneration and thickness was performed by two independent and blinded readers (R1 and R2). Gross anatomy and MR arthrography evaluated by two readers in consensus served as the reference standard. The joint surface not accessible to US was measured.

Results

US interreader agreement was non-existent for cartilage thickness measurements and moderate for cartilage degeneration grading (weighted kappa = 0.41).Comparing US and MR imaging evaluation, there was no correlation between US R1 and MR imaging (Pearson correlation coefficient [PCC] = 0.352) and a moderate correlation between US R2 and MR imaging (PCC = 0.570) concerning cartilage thickness measurements. Concerning cartilage degeneration grading, there was a moderate to strong (R1 Spearman correlation coefficient [SCC] = 0.729)/R2 SCC = 0.767) correlation concerning cartilage degeneration grading.Comparing US and gross anatomic evaluation, there was no correlation for US R1 (PCC = 0.220) and a strong correlation for US R2 (PCC = 0.922) concerning cartilage thickness measurements, and a strong to moderate correlation (R1 SCC = 0.808/R2 SCC = 0.597) concerning cartilage degeneration grading.The mean sector of the articular surface of the ulna head not accessible to US was 13°.

Conclusion

In conclusion the DRUJ is accessible to US except in the central 13° sector of the joint surface. US was approved to be sufficient in demonstrating advanced stages of cartilage degeneration. Thus, US of the DRUJ is recommended in patients suffering from ulnar-sided wrist pain.     

MR arthrography of the hip joint

MR arthrography of the hip joint is usually performed after a conventional MRI has been obtained to rule out other pathologies of the hip joint as for instance bone marrow edema or osteonecrosis of the hip. MR arthrography is mainly performed as a very special investigation, and it is executed in most cases if the clinician asks for the diagnosis of a labral lesion. In very rare cases, MR arthrography of the hip is performed to image cartilage disease or osteochondrosis dissecans or free intraarticular bodies. In this paper, the indications, the technique, and the most important pathology of the hip joint--labral lesions--will be described as well as variants of the normal acetabular labrum. After a conventional MRI of the hip joint has been performed, a MR arthrography of the hip will be obtained to search for labral pathology or cartilage disease. MR arthrography is obtained after the intraarticular injection of 10-20 ml of a 0.1 mmol solution of gadopentate-dimeglumine has been performed. The intraarticular injection can either be fluoroscopic-guided or CT-guided or directly MR-guided. After the intraarticular injection, MR arthrography will be performed by the use of paracoronal and parasagittal T1-weighted spin echo or gradient echo sequences. In cases of labral lesions (degeneration, labral tear, labral detachment) or cartilage disease MR arthrography proved to be more sensitive as conventional MRI as shown in the literature. The sensitivity of MRI to detect labral pathology was reported to be about 65%, and that of MR arthrography was reported to be about 92-95% compared to surgical results. According to the current literature, MR arthrography is the most sensitive method to delineate these kind of pathologies. Therefore, the invasive technique of MR arthrography may be justified for the correct diagnosis of these kind of pathologies after other pathologic entities have been ruled out by conventional MRI.     

Direct arthrography of the pisotriquetral joint

OBJECTIVE: The purpose of this study was to describe and evaluate a simple and safe procedure for direct arthrography of and steroid injection into the pisotriquetral joint. CONCLUSION: Direct pisotriquetral arthrography using a medial approach is an effective and easy-to-perform technique for injection of steroids.     

MR arthrography detects subtle joint pathology

In the inevitable cost-benefit analysis to come, the appropriate role of MR arthrography will rightly be challenged. As arthroscopic and MR imaging techniques become even more widespread and refined, a well-defined niche for MR arthrography will eventually emerge.     

Oblique head position in temporomandibular joint arthrography

Thirteen patients were prospectively studied with arthrography to determine whether oblique head positions were helpful in diagnosing internal derangement of the temporomandibular joint (TMJ). After injection of contrast material, inclined transcranial lateral spot films were obtained with the patient's head in upward oblique, downward oblique, and neutral positions. The spot films were analyzed for internal derangement by assessing the size of the mass effect on the arthrogram. Twelve of the 13 arthrograms showed evidence of internal derangement of the TMJ. However, the apparent size of the mass effect varied in different head positions. Each of the three views failed to demonstrate the mass effect in at least one instance (eight different patients). No head position was better than another in demonstrating the mass effect. Thus, oblique head positions are useful adjuncts for diagnosing internal derangement of the TMJ.     

Traumatic disorders of the distal radioulnar joint.

Trauma can lead to isolated or associated distal radioulnar joint disorders. Instability or incongruity of the joint frequently leads to pain, weakness, and limited forearm rotation. A knowledge of the anatomy and biomechanics is helpful to understand the pathology and to formulate a treatment protocol. This article reviews the surgical options that have been proposed to correct derangements of the distal radioulnar joint resulting from trauma.