Radiographic Arthrography Hand There is no relevant literature to support the use of radiographic arthrography in the setting of chronic hand pain and normal radiographs or radiographs remarkable for nonspecific arthritis. US Hand US can be used to identify synovitis, joint effusion, tenosynovitis, tendinopathy and tendon injury, pulley injury, CTS, and retained foreign body [6,13-16]. The American College of Rheumatology has concluded there is reasonable evidence to support the use of musculoskeletal US in patients without definitive diagnosis presenting with pain, swelling, or mechanical symptoms of the metacarpophalangeal and interphalangeal joints, and US is reasonable to evaluate tendon and soft tissue pathology of the hand [14]. In a study of patients referred from hand surgeons, US of the hand and wrist was contributory to the clinical assessment, defined as confirming the clinical suspicion or modifying the diagnostic/therapeutic plan, in 76% of all patients and 67% of patient who presented without a history of trauma [17]. Chronic Hand and Wrist Pain Variant 4: Adult. Chronic wrist pain. Radiographs show old scaphoid fracture. Evaluate for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. Next imaging study. Bone Scan Wrist There is no relevant literature to support the use of bone scan in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. CT Arthrography Wrist There is no relevant literature to support the use of CT arthrography in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, or osteonecrosis. If the specific clinical concern requires assessment of the articular cartilage in post-traumatic osteoarthritis, the spatial resolution of CT when combined with intra-articular contrast makes CT arthrography an ideal study.
Chronic Hand and Wrist Pain. Radiographic Arthrography Hand There is no relevant literature to support the use of radiographic arthrography in the setting of chronic hand pain and normal radiographs or radiographs remarkable for nonspecific arthritis. US Hand US can be used to identify synovitis, joint effusion, tenosynovitis, tendinopathy and tendon injury, pulley injury, CTS, and retained foreign body [6,13-16]. The American College of Rheumatology has concluded there is reasonable evidence to support the use of musculoskeletal US in patients without definitive diagnosis presenting with pain, swelling, or mechanical symptoms of the metacarpophalangeal and interphalangeal joints, and US is reasonable to evaluate tendon and soft tissue pathology of the hand [14]. In a study of patients referred from hand surgeons, US of the hand and wrist was contributory to the clinical assessment, defined as confirming the clinical suspicion or modifying the diagnostic/therapeutic plan, in 76% of all patients and 67% of patient who presented without a history of trauma [17]. Chronic Hand and Wrist Pain Variant 4: Adult. Chronic wrist pain. Radiographs show old scaphoid fracture. Evaluate for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. Next imaging study. Bone Scan Wrist There is no relevant literature to support the use of bone scan in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. CT Arthrography Wrist There is no relevant literature to support the use of CT arthrography in the setting of chronic wrist pain, remote scaphoid fracture, and clinical concern for nonunion, malunion, or osteonecrosis. If the specific clinical concern requires assessment of the articular cartilage in post-traumatic osteoarthritis, the spatial resolution of CT when combined with intra-articular contrast makes CT arthrography an ideal study.