The rumors of my demise are greatly exaggerated.

MARK TWAIN

Wrist arthrography emerged in 1961<sup>13Kessler I., Silberman Z. An experimental study of the radiocarpal joint by arthrography Surg Gynecol Obstet 1961 ;  112 : 33-44

Cliccare qui per andare alla sezione Riferimenti</sup> 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,<sup>5Chung K.C., Zimmerman N.B., Travis M.T. Wrist arthrography versus arthroscopy: A comparative study of 150 cases J Hand Surg [Am] 1996 ;  21 : 591-594 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 45Weiss A.C., Akelman E., Lambiase R. Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy J Bone Joint Surg Am 1996 ;  78 : 348-356

Cliccare qui per andare alla sezione Riferimenti</sup> and for being poorly predictive of symptomatology.<sup>12Herbert T.J., Faithful R.G., McCann D.J., e al. Bilateral arthrography of the wrist J Hand Surg [Br] 1990 ;  15 : 233-235 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 14Kirschenbaum D., Sieler S., Solonick D., e al. Arthrography of the wrist: Assessment of the integrity of the ligaments in young asymptomatic adults J Bone Joint Surg Am 1995 ;  77 : 1207-1209

Cliccare qui per andare alla sezione Riferimenti, 18Manaster B.J., Mann R.J., Rubenstein S. Wrist pain: Correlation of clinical and plain film findings with arthrographic results J Hand Surg [Am] 1989 ;  14 : 466-473 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 48Yin Y., Evanoff B., Gilula L.A., e al. Evaluation of selective wrist arthrography of contralateral asymptomatic wrists for symmetric ligamentous defects AJR Am J Roentgenol 1996 ;  166 : 1067-1073

Cliccare qui per andare alla sezione Riferimenti</sup> At least one leading musculoskeletal radiologist has predicted that wrist arthrography will soon be an obsolete procedure.<sup>6Dalinka M.K. MR imaging of the wrist AJR Am J Roentgenol 1995 ;  164 : 1-8

Cliccare qui per andare alla sezione Riferimenti</sup>

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 compartment<sup>3Brown J.A., Janzen D.L., Brendan D.A., e al. Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain Can Assoc Radiol J 1994 ;  45 : 292-296

Cliccare qui per andare alla sezione Riferimenti, 14Kirschenbaum D., Sieler S., Solonick D., e al. Arthrography of the wrist: Assessment of the integrity of the ligaments in young asymptomatic adults J Bone Joint Surg Am 1995 ;  77 : 1207-1209

Cliccare qui per andare alla sezione Riferimenti, 26Resnick D., Andre M., Kerr R., e al. Digital arthrography of the wrist: A radiographic-pathologic investigation AJR Am J Roentgenol 1984 ;  142 : 1187-1190

Cliccare qui per andare alla sezione Riferimenti</sup> to bilateral triple compartment injections.<sup>5Chung K.C., Zimmerman N.B., Travis M.T. Wrist arthrography versus arthroscopy: A comparative study of 150 cases J Hand Surg [Am] 1996 ;  21 : 591-594 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 16Levinsohn E.M., Palmer A.K., Coren A.B., e al. Wrist arthrography: The value of the three compartment injection technique Skeletal Radiol 1987 ;  16 : 539-544 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 17Levinsohn E.M., Rosen I.D., Palmer A.K. Wrist arthrography: Value of the three-compartment injection method Radiology 1991 ;  179 : 231-239

Cliccare qui per andare alla sezione Riferimenti, 48Yin Y., Evanoff B., Gilula L.A., e al. Evaluation of selective wrist arthrography of contralateral asymptomatic wrists for symmetric ligamentous defects AJR Am J Roentgenol 1996 ;  166 : 1067-1073

Cliccare qui per andare alla sezione Riferimenti</sup> One group used varying dilutions of iodinated contrast material in order to inject all three compartments successively.<sup>11Helms C.A., Major N.M. Rapid triple-compartment wrist arthrography with diluted contrast medium Can Assoc Radiol J 1993 ;  44 : 227

Cliccare qui per andare alla sezione Riferimenti</sup> In some investigations, the source of the communication between joints was frequently not identified.<sup>30Shigematsu S., Abe M., Onomura T., e al. Arthrography of the normal and posttraumatic wrist J Hand Surg [Am] 1989 ;  14 : 410-412 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 37Tirman R.M., Weber E.R., Snyder L.L., e al. Midcarpal wrist arthrography for detection of tears of the scapholunate and lunotriquetral ligaments AJR Am J Roentgenol 1985 ;  144 : 107-108

Cliccare qui per andare alla sezione Riferimenti</sup> 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.