Abstract
Introduction
The wrist arthroscopy has been performed since 1979. With the advances in technology and surgical expertise, wrist arthroscopy has become third commonest procedure after knee and shoulder joint. Wrist arthroscopy has become a gold standard for diagnosing TFCC pathologies and other intercarpal disorders. Our aim was to compare the clinical, MRI and arthroscopic findings while treating various wrist pathologies.
Materials/Method
In retrospective trial, 30 patients (19 male and 11 female) with clinical evidence of wrist lesions were evaluated with MRI followed by wrist arthroscopy. The mean age of the patients at the time of outpatient appointment was 44 years with an average waiting time of 6.6 months. Inclusion criteria: all patients undergoing wrist surgery. Exclusion criteria: septic arthritis, acute distal radius fractures. Kappa analysis was used to compare the three methods of wrist pathology assessment. The total 30 patients were assessed for clinical findings, MRI report and corresponding arthroscopic findings.
Results
According to the clinical findings, 22 patients (68% of all patients) were diagnosed with suspected TFCC injury. In 21 patients, the MRI showed TFCC tear (partial to complete) and this was confirmed by arthroscopy in 22 patients. There was a correlation of clinical, MRI and arthroscopy in detecting TFCC lesions in 95% cases. Sensitivity 93%, specificity 90%, positive predictive value 89% and negative predictive value 94%. The Scapho-lunate ligament tear was suspected in 8 (28% of all patients). In 6 patients, MRI showed scapho-lunate tear and this was confirmed by wrist arthroscopy in 10 patients. Correlation with wrist arthroscopy was 80%, sensitivity 94%, specificity 92%, positive predictive value 90% and negative predictive value 93%. 15 patients (50% of all patients) showed signs of moderate to severe cartilage wear and 12 patients had confirmation with MRI. Correlation with wrist arthroscopy was 75%, Sensitivity 90%, Specificity 91%, positive predictive value 89% with negative predictive value 92%. However clinical examination and MRI had poor correlation with wrist arthroscopy in diagnosing synovitis.
Discussion
The MRI and wrist arthroscopy has fair correlation, though MRI sensitivity approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intra-articular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future. Our results showed clinical examination is crucial for diagnosing wrist pathologies, MRI can be used as an adjunct but the wrist arthroscopy still remains the gold standard tool for diagnosis and therapeutic interventions.
