For purposes of this variant, a nonspecific arthritis is defined as articular changes at a single joint and/or a pattern of arthritis throughout the hand and wrist that, when combined with the appropriate clinical history, does not allow distinction between degenerative or post-traumatic osteoarthritis, inflammatory arthritis, and crystalline arthritis. Bone Scan Wrist There is no relevant literature discussing routine use of bone scan in the assessment of nonspecific chronic wrist pain. Bone scans offer the ability to differentiate metabolically active abnormalities, which may be the cause of pain, from those that are inactive [19]. Bone scans can reliably detect chronic or occult scaphoid fracture with a sensitivity and specificity of 97% and 89%, respectively [20]. Although bone scans are sensitive for the detection of bone abnormalities, the findings may be nonspecific [19]. There are established imaging patterns for fracture, osteonecrosis, nonunited fracture, arthritis, and complex regional pain syndrome [19]. Bone scan of the wrist offers improved specificity when single-photon emission CT is performed [19]. CT Arthrography Wrist Performing arthrography before a CT scan of the wrist aids in the detection of ligament injuries and cartilage abnormalities. CT arthrography allows direct visualization of full thickness ligament tears and visualization of partial thickness tears of the appropriate compartment [6,21]. An interdisciplinary group of hand surgeons and radiologists supports the use of CT arthrography for the assessment of clinically suspected scapholunate instability and cartilage defects [18]. CT arthrography has demonstrated a sensitivity, specificity, and accuracy between 92% and 94% for triangular fibrocartilage (TFC) complex tears, between 80% and 100% for intrinsic ligament tears located within the proximal carpal compartment, and between 94% and 100% for articular cartilage abnormalities [22].
Chronic Hand and Wrist Pain. For purposes of this variant, a nonspecific arthritis is defined as articular changes at a single joint and/or a pattern of arthritis throughout the hand and wrist that, when combined with the appropriate clinical history, does not allow distinction between degenerative or post-traumatic osteoarthritis, inflammatory arthritis, and crystalline arthritis. Bone Scan Wrist There is no relevant literature discussing routine use of bone scan in the assessment of nonspecific chronic wrist pain. Bone scans offer the ability to differentiate metabolically active abnormalities, which may be the cause of pain, from those that are inactive [19]. Bone scans can reliably detect chronic or occult scaphoid fracture with a sensitivity and specificity of 97% and 89%, respectively [20]. Although bone scans are sensitive for the detection of bone abnormalities, the findings may be nonspecific [19]. There are established imaging patterns for fracture, osteonecrosis, nonunited fracture, arthritis, and complex regional pain syndrome [19]. Bone scan of the wrist offers improved specificity when single-photon emission CT is performed [19]. CT Arthrography Wrist Performing arthrography before a CT scan of the wrist aids in the detection of ligament injuries and cartilage abnormalities. CT arthrography allows direct visualization of full thickness ligament tears and visualization of partial thickness tears of the appropriate compartment [6,21]. An interdisciplinary group of hand surgeons and radiologists supports the use of CT arthrography for the assessment of clinically suspected scapholunate instability and cartilage defects [18]. CT arthrography has demonstrated a sensitivity, specificity, and accuracy between 92% and 94% for triangular fibrocartilage (TFC) complex tears, between 80% and 100% for intrinsic ligament tears located within the proximal carpal compartment, and between 94% and 100% for articular cartilage abnormalities [22].