THE BENEFIT OF INTRA-OPERATIVE ARTHROGRAPHY WITH WRIST ARTHROSCOPY

Abstract

Aims: Chronic wrist pain has always been a diagnostic challenge. With the introduction of wrist arthroscopy and MRI, previously used techniques such as arthrography and cineradiography were made redundant. However the gold standard of wrist arthroscopy can still fail to diagnose the problem in some patients with chronic wrist pain. The aim of this study was to demonstrate that the combination of arthroscopy with arthrography gives more information, therefore permitting a clearer diagnosis in these patients.

Methods: A retrospective cohort study of 40 consecutive patients who underwent wrist arthroscopy for chronic wrist pain, between November 2003 and October 2005. All patients had their investigation and management by a single upper limb consultant orthopaedic surgeon. All had plain x-rays, 42.5% had MRI prior to surgery, and all but one had an intra-operative arthrogram, performed under the same anaesthetic as for the wrist arthroscopy. All demographic data was collected along with history of the patient’s wrist pain, examination, investigations and management.

Results: The results showed a ratio of patients 21M: 19F with mean age of 38 years in males and 40 years in females. On examination 15% demonstrated pain with carpal instability. 55% showed pathological findings on their X-rays. 82% of those who had an MRI, had a pathological finding. 97.5% had wrist arthrograms intra-operatively. 56% of these showed pathological findings on wrist arthrogram. In 18%, it altered the differential diagnosis prior to performing the arthroscopy and 38% it reinforced our diagnosis.

The final diagnoses after wrist arthrogram and arthroscopy were 42.5% with TFCC injuries, 20% with SNAC pathology, 20% with synovitis with no other pathology, 10% with carpal ligamentous pathology and 7.5% with radiocarpal osteoarthritis.

Conclusions: Performing an arthrogram initially provided more information, thereby allowing the surgeon to undertake the arthroscopy with increased accuracy. It also permitted the diagnosis of more subtle findings.

Therefore, the arthrogram is another tool in the diagnosis of wrist pathology, and should not be forgotten. It is especially useful in patients with chronic wrist pain, where the diagnosis may be more complicated.