Loyola-Luna O, Gargollo-Orvañanos C, Martinez-Dunker D

Language: Spanish
References: 12
Page: 390-396
PDF size: 362.32 Kb.

ABSTRACT

Introduction: wrist ligament injuries and triangular fibrocartilage complex (TFCC) lesions are common but often underdiagnosed conditions causing chronic wrist pain. The diagnostic challenge necessitates a combination of clinical examination, imaging studies, and arthroscopy, considered the gold standard. Ligament injuries, particularly scapholunate ligament (SL), and TFCC lesions account for significant wrist instability and ulnar-sided wrist pain, respectively. Material and methods: this retrospective observational study, conducted at Hospital Ángeles Pedregal, Mexico City, aimed to assess the diagnostic accuracy of wrist magnetic resonance imaging (MRI) compared to arthroscopic findings. The sample included patients with clinical suspicion of wrist ligament or TFCC lesions who underwent both wrist MRI and arthroscopy. Clinical examination maneuvers were also evaluated. The study assessed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each diagnostic modality. Results: arthroscopic evaluation, considered the gold standard, revealed a high prevalence of TFCC and scapholunate ligament lesions (96.6% and 96.6%, respectively). Sensitivity for TFCC lesions on MRI was 71.4%, with 100% specificity. For ligament injuries (SL, lunotriquetral, and radioscapholunate), sensitivities ranged from 21.4% to 60.7%, with 100% specificity. Clinical examination showed higher sensitivity (29.2% to 89.3%) but lower specificity (0% to 100%) compared to MRI. Conclusion: wrist MRI remains the non-invasive imaging choice, although discrepancies exist between MRI and arthroscopic findings, emphasizing the need for careful interpretation. Clinical examination enhances sensitivity but lacks specificity. The study highlights the ongoing challenge in achieving optimal diagnostic accuracy for wrist ligament and TFCC lesions, emphasizing the importance of a multimodal diagnostic approach.

REFERENCES

1. Chennagiri RJR, Lindau TR. Assessment of scapholunate instability and review of evidence for management in the absence of arthritis. J Hand Surg Eur Vol. 2013; 38(7): 727-38.

2. Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin. 2011; 27(3): 263-72. doi: 10.1016/j.hcl.2011.05.014.

3. Morley J, Bidwell J, Bransby-Zachary M. A comparison of the findings of wrist arthroscopy and magnetic resonance imaging in the investigation of wrist pain. J Hand Surg Br. 2001; 26(6): 544-6.

4. Tanaka T, Yoshioka H, Ueno T, Shindo M, Ochiai N. Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury. J Hand Surg Am. 2006; 31(8): 1308-14.

5. Michelotti BF, Adkinson JM, Chung KC. Chronic scapholunate ligament injury. techniques in repair and reconstruction. Hand Clin. 2015; 31(3): 437-49. doi: 10.1016/j.hcl.2015.04.013.

6. Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of magnetic resonance imaging and clinical tests in diagnostics of wrist ligament injuries: a systematic review. Arthroscopy. 2015; 31(10): 2014-2020.e2. doi: 10.1016/j.arthro.2015.04.090.

7. Young D, Papp S, Giachino A. Physical examination of the wrist. Hand Clin. 2010; 26(1): 21-36. doi: 10.1016/j.hcl.2009.08.010.

8. Palmer AK. Triangular fibrocartilage disorders: Injury patterns and treatment. Arthroscopy. 1990; 6(2): 125-32.

9. Zanetti M, Bram J, Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: Does MR arthrography improve standard MRI? J Magn Reson Imaging. 1997; 7(3): 590-4.

10. De Santis S, Cozzolino R, Luchetti R, Cazzoletti L. Comparison between MRI and arthroscopy of the wrist for the assessment of posttraumatic lesions of intrinsic ligaments and the triangular fibrocartilage complex. J Wrist Surg. 2021; 11(1): 28-34. doi: 10.1055/s-0041-1729757.

11. Hafezi-Nejad N, Carrino JA, Eng J, Blackmore C, Shores J, Lifchez SD, et al. Scapholunate interosseous ligament tears: diagnostic performance of 1.5 T, 3 T MRI, and MR arthrography-A systematic review and meta-analysis. Acad Radiol. 2016; 23 (9): 1091-103. doi: 10.1016/j.acra.2016.04.006.

12. Arroyo-Berezowsky C, Quinzaños-Fresnedo J. Epidemiología de las lesiones de mano y muñeca tratadas en un centro especializado de referencia durante un año. Acta Ortop Mex. 2021; 35(5): 429-35. doi:10.35366/104570.

EVIDENCE LEVEL

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