A study of 18 patients demonstrated good correlation between cartilage lesions at 3.0T MRI and arthroscopy [37]. If a study is specifically performed to assess the intrinsic ligaments or TFC, MR arthrography has been demonstrated to be superior to MRI without IV contrast [30-32,41]. MRI is helpful in the diagnosis of tendon abnormalities including tendinopathy, tenosynovitis, and intersection syndromes [12,13,42,43]. In a retrospective review of 316 consecutive patients referred to a hand surgeon with MRI of the hand or wrist, MRI changed clinical management in 69.5% of cases [44]. MRI was particularly useful in reassuring patients that no further follow-up was necessary in 70% of cases [44]. Radiographic Arthrography Wrist There is no relevant literature to support the use of radiographic arthrography of the wrist in the setting of chronic wrist pain and normal or nonspecific radiographs. Although a meta-analysis has demonstrated a pooled sensitivity of 76.2% and a specificity of 92.5% for the detection of complete TFC complex tear, radiographic arthrography is not routinely performed in isolation [45]. In current practice it is infrequently performed as a standalone imaging examination; rather, it is typically performed in conjunction with CT or MR arthrography. Radiography Wrist Additional Views A variety of additional radiographic projections of the wrist may be obtained to supplement the standard 3-view series depending on the specific clinical indication. However, there is no recent literature to support obtaining additional views in the setting of chronic wrist pain and normal or nonspecific radiographs. An interdisciplinary group of hand surgeons and radiologists consensus statements concluded stress views are indicated for the diagnosis of scapholunate instability [18].
Chronic Hand and Wrist Pain. A study of 18 patients demonstrated good correlation between cartilage lesions at 3.0T MRI and arthroscopy [37]. If a study is specifically performed to assess the intrinsic ligaments or TFC, MR arthrography has been demonstrated to be superior to MRI without IV contrast [30-32,41]. MRI is helpful in the diagnosis of tendon abnormalities including tendinopathy, tenosynovitis, and intersection syndromes [12,13,42,43]. In a retrospective review of 316 consecutive patients referred to a hand surgeon with MRI of the hand or wrist, MRI changed clinical management in 69.5% of cases [44]. MRI was particularly useful in reassuring patients that no further follow-up was necessary in 70% of cases [44]. Radiographic Arthrography Wrist There is no relevant literature to support the use of radiographic arthrography of the wrist in the setting of chronic wrist pain and normal or nonspecific radiographs. Although a meta-analysis has demonstrated a pooled sensitivity of 76.2% and a specificity of 92.5% for the detection of complete TFC complex tear, radiographic arthrography is not routinely performed in isolation [45]. In current practice it is infrequently performed as a standalone imaging examination; rather, it is typically performed in conjunction with CT or MR arthrography. Radiography Wrist Additional Views A variety of additional radiographic projections of the wrist may be obtained to supplement the standard 3-view series depending on the specific clinical indication. However, there is no recent literature to support obtaining additional views in the setting of chronic wrist pain and normal or nonspecific radiographs. An interdisciplinary group of hand surgeons and radiologists consensus statements concluded stress views are indicated for the diagnosis of scapholunate instability [18].