WRIST ARTHROGRAPHY TODAY - 09/09/11
Résumé |
The rumors of my demise are greatly exaggerated.
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MARK TWAIN
Wrist arthrography emerged in 196113 as a technique to evaluate the intercarpal ligaments and flourished over the next two decades. In the last several years, however, various investigators have criticized wrist arthrography for being insensitive to many ligamentous defects seen during arthroscopy,5, 45 and for being poorly predictive of symptomatology.12, 14, 18, 48 At least one leading musculoskeletal radiologist has predicted that wrist arthrography will soon be an obsolete procedure.6
What factors account for such a precipitous rise and fall in popularity? Are there problems with studies that have criticized the technique or with those that have advocated its use? Is the technique itself inherently limited in its ability to provide relevant clinical information versus other imaging techniques? Are we limited in our knowledge of the characteristics of carpal ligament injuries?
Review of the literature shows considerable variation in examination technique, ranging from the injection of a single compartment3, 14, 26 to bilateral triple compartment injections.5, 16, 17, 48 One group used varying dilutions of iodinated contrast material in order to inject all three compartments successively.11 In some investigations, the source of the communication between joints was frequently not identified.30, 37 Yet, the presence of a communication was used as presumptive evidence of a ligament tear.
Aside from the technical shortcomings of many of these studies, it is evident that there has been an evolving understanding of the characteristics of ligament trauma and attritional alterations that is still incomplete. Until the body of scientific knowledge in this area is more comprehensive, all imaging methods, including arthroscopy, will have some limitations in their ability to accurately predict pathology.
We believe that if the radiologist uses meticulous technique and diligent observation, understands the anatomy of the carpal ligaments, and is familiar with what is known in the literature regarding ligament trauma and age-related alterations, the use of arthrographically enhanced imaging has the potential to provide an equivalent diagnostic evaluation as arthroscopy. Indeed, the ability to perform bilateral wrist arthrography to look for symmetric asymptomatic defects is an advantage wrist arthrography has over wrist arthroscopy.
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| Address reprint requests to Louis A. Gilula, MD, Musculoskeletal Radiology Section, Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St. Louis, MO 63110 |
Vol 36 - N° 4
P. 651-672 - juillet 1998 Retour au numéro
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