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Skeletal Radiology Aug 2022To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.
PURPOSE
To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.
METHODS
Between 7/1/14 and 11/30/20, we performed 42 injections in 33 patients with ulnar-sided wrist pain, referred by clinicians who suspected the PTJ as the pain generator. There were 16 males and 17 females, average age 46.7 years. The patients were positioned in one of five ways: sitting with the hand maximally supinated; sitting with the hand maximally pronated; supine with the elbow flexed across the chest and the ulnar aspect of the wrist facing upward; supine with the elbow flexed, the arm externally rotated, and the ulnar aspect of the wrist facing upward; prone with the symptomatic hand at their side and the ulnar aspect of the wrist facing upward.
RESULTS
The procedures were performed by any of twelve fellowship-trained musculoskeletal radiologists. Fifteen patients reported immediate relief of symptoms, including 6 patients whose pisotriquetral joints were normal sonographically. Four patients underwent subsequent surgical excision of their pisiforms and the fifth underwent arthroscopic debridement of the pisotriquetral joint.
CONCLUSION
Ultrasound is a facile imaging modality for guiding pisotriquetral injections, which may be accomplished with a variety of patient positions and injection techniques.
Topics: Arthralgia; Carpal Joints; Female; Humans; Male; Middle Aged; Pisiform Bone; Ultrasonography, Interventional; Wrist Joint
PubMed: 35079865
DOI: 10.1007/s00256-022-03992-z -
Journal of Ultrasound in Medicine :... May 2021To compare the diagnostic performance between strain elastography and shear wave elastography (SWE) for the diagnosis of carpal tunnel syndrome (CTS).
OBJECTIVES
To compare the diagnostic performance between strain elastography and shear wave elastography (SWE) for the diagnosis of carpal tunnel syndrome (CTS).
METHODS
Between July 2018 and June 2019, 66 consecutive patients with 95 imaged wrists underwent wrist ultrasound, including grayscale ultrasound, strain elastography, and SWE, because of the suspicion of CTS. During wrist ultrasound, the cross-sectional area (CSA), strain ratio, elasticity, and shear wave velocity of each median nerve were measured at the proximal carpal bone level (scaphoid to pisiform). The variables were compared between the normal and CTS groups by using the independent t test, and subgroup analyses were performed using one-way analysis of variance. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of each variable.
RESULTS
CSA, elasticity, and shear wave velocity showed significant intergroup differences (P < 0.001, P < 0.001, and P = 0.002, respectively). However, the strain ratio showed no statistically significant intergroup difference (P = 0.639). In the subgroup analyses, elasticity showed significantly higher values in the severe group than in the mild and moderate groups (P < 0.001 and P = 0.001, respectively). Other parameters showed no significant differences among the different subgroups. The areas under the ROC curve were 0.823 for CSA, 0.772 for elasticity, and 0.779 for shear wave velocity. The differences in the areas under the ROC curve among CSA, elasticity, and shear wave velocity were not statistically significant (all P > 0.05).
CONCLUSIONS
SWE has a good diagnostic value in CTS. In particular, elasticity can discriminate the severe group from the other groups.
Topics: Carpal Tunnel Syndrome; Elasticity Imaging Techniques; Humans; Median Nerve; Wrist; Wrist Joint
PubMed: 32852107
DOI: 10.1002/jum.15478 -
Current Problems in Diagnostic Radiology 2020To use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction... (Comparative Study)
Comparative Study
OBJECTIVE
To use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction studies (NCS) as the gold standard.
MATERIAL AND METHODS
In this prospective study, 26 patients with CTS (45 wrists; 22 female and 4 male patients; mean ± SD age of 49.42 + 14.47 years) and 19 age and sex matched healthy volunteers (32 wrists; 15 female and 4 male volunteers, mean ± SD age of 42.52 + 10.85 years) underwent MRI and USG. Cross-sectional area (CA) of median nerve was measured using free hand ROI at four levels: hamate hook (H0), pisiform bone (PI0), 1 cm proximal (PI1) and 2 cm proximal to PI0 (PI2). Relative median nerve signal intensity (MNSI) was calculated as ratio of median nerve signal intensity with hypothenar muscle signal intensity. Flexor retinacular bowing was calculated at hamate hook level. Echogenicity and Power Doppler vascularity of median nerve were assessed on USG. Independent t-test, chi square test and receiver operating characteristic curve analysis were used as appropriate.
RESULTS
On USG, CA measured at PI0 (95% confidence interval of 0.872-0.987) and retinacular bowing (0.816-0.912), while, on MRI, CA at PI1 (0.874-0.997) were most useful in diagnosing CTS based on the ROC and Zombie plot analysis. Area under curves for CA measurements on USG and MRI were not significantly different. CA at PI1 on MRI (0.752-0.965) was significantly different between minimal to moderate CTS and severe to extreme CTS groups (on NCS).
CONCLUSION
CA of median nerve is the most useful parameter to diagnose and grade CTS and USG and MRI are comparable for measurements. Increased retinacular bowing on USG and hypoechogenicity of median nerve increase the diagnostic confidence while MRI helps in picking up important associated conditions.
Topics: Adult; Carpal Tunnel Syndrome; Female; Humans; Magnetic Resonance Imaging; Male; Median Nerve; Middle Aged; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography; Wrist Joint
PubMed: 31126663
DOI: 10.1067/j.cpradiol.2019.04.004 -
Medicina (Kaunas, Lithuania) Mar 2024We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and...
We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions.
Topics: Humans; Adolescent; Male; Pisiform Bone; Fracture Dislocation; Fractures, Bone; Wrist Injuries
PubMed: 38674178
DOI: 10.3390/medicina60040532 -
Journal of Rheumatic Diseases Jan 2023The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic...
OBJECTIVE
The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls.
METHODS
Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI.
RESULTS
Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001).
CONCLUSION
CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients.
PubMed: 37476525
DOI: 10.4078/jrd.22.0028 -
Diagnostics (Basel, Switzerland) Mar 2022: We investigated whether opportunistic screening for osteoporosis can be done from computed tomography (CT) scans of the wrist/forearm using machine learning. A...
: We investigated whether opportunistic screening for osteoporosis can be done from computed tomography (CT) scans of the wrist/forearm using machine learning. A retrospective study of 196 patients aged 50 years or greater who underwent CT scans of the wrist/forearm and dual-energy X-ray absorptiometry (DEXA) scans within 12 months of each other was performed. Volumetric segmentation of the forearm, carpal, and metacarpal bones was performed to obtain the mean CT attenuation of each bone. The correlations of the CT attenuations of each of the wrist/forearm bones and their correlations to the DEXA measurements were calculated. The study was divided into training/validation (n = 96) and test (n = 100) datasets. The performance of multivariable support vector machines (SVMs) was evaluated in the test dataset and compared to the CT attenuation of the distal third of the radial shaft (radius 33%). There were positive correlations between each of the CT attenuations of the wrist/forearm bones, and with DEXA measurements. A threshold hamate CT attenuation of 170.2 Hounsfield units had a sensitivity of 69.2% and a specificity of 77.1% for identifying patients with osteoporosis. The radial-basis-function (RBF) kernel SVM (AUC = 0.818) was the best for predicting osteoporosis with a higher AUC than other models and better than the radius 33% (AUC = 0.576) ( = 0.020). Opportunistic screening for osteoporosis could be performed using CT scans of the wrist/forearm. Multivariable machine learning techniques, such as SVM with RBF kernels, that use data from multiple bones were more accurate than using the CT attenuation of a single bone.
PubMed: 35328244
DOI: 10.3390/diagnostics12030691 -
Computational and Mathematical Methods... 2020In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated....
In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated. We hypothesize that a change in the anatomical angle of the hamatum curvature changes the carpal tunnel volume. To prove our hypothesis, we used a mathematical simulation model considering the carpal tunnel as a truncated cone. We reviewed the wrist CT scans of 91 adults (>18 years of age), including 51 men and 40 women. We measured the angle of the hamatum curvature in the CT scans. We measured cross-sectional areas at the outlet of the carpal tunnel at the level of the trapezium and hook of hamate (1) and at the inlet at the level of the scaphoid and pisiform (2) and the length () of the carpal tunnel. We attempted to calculate the effect of 2 degree by 2-degree changes in the angle of the hamatum curvature between the angles of 98° and 140° on the carpal tunnel volume. The mean angle of the hook of hamatum of the subjects was 122.55° ± 8.20° (range, 97.20° - 139.31°). No suitable cutoff point was found for the angle values. There was no difference between the gender groups according to the angle value. The data clearly show that there is a high correlation between carpal tunnel volume and the angle of hamatum curvature. The results of our study emphasize the importance of taking into account the anatomical features of the hamatum bone, especially the angle of curvature, which may play a predisposing role in idiopathic carpal tunnel syndrome.
Topics: Adult; Carpal Bones; Carpal Tunnel Syndrome; Computational Biology; Computer Simulation; Female; Hamate Bone; Humans; Imaging, Three-Dimensional; Male; Models, Anatomic; Tomography, X-Ray Computed; Young Adult
PubMed: 32617118
DOI: 10.1155/2020/7582181 -
Orthopedics Sep 2019Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation....
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation. Recently, ultrasonography has been introduced as a promising noninvasive diagnostic alternative. In this study, the authors compared ultrasonography with neurophysiological findings for the diagnosis of CTS in 96 patients/hands with clinical symptoms of CTS. The latency, amplitude, distance, and velocity of the median and ulnar nerves were measured. Needle electromyography was performed in the abductor pollicis brevis, in addition to muscles of the arm and forearm, to exclude proximal median nerve, brachial plexus, or radicular abnormalities. Ultrasonography was based on the morphologic/anatomic changes of the median nerve cross-sectional area in the sagittal plane of the wrist at the level of the pisiform bone, the changes of its regional echogenicity, and the identification of coexisting pathologies, such as tenosynovitis, space-occupying lesions, supplementary muscles, and vessels, that may provoke indirectly an increase of the pressure in the carpal tunnel. Eighty-seven (90%) of the 96 patients/hands with clinical symptoms of CTS showed positive findings in both ultrasonography and nerve conduction studies. Six (6%) patients showed positive findings only in nerve conduction studies, and 3 (3%) patients showed positive findings only in ultrasonography; the difference was not statistically significant. The sensitivity and the specificity of nerve conduction studies compared with ultrasonography was 97% and 89% compared with 94% and 55%, respectively. A positive correlation and proportional increase of the ultrasonography measurements compared with the increase of the nerve conduction studies severity was observed. [Orthopedics. 2019; 42(5):e460-e464.].
Topics: Carpal Tunnel Syndrome; Electromyography; Female; Humans; Median Nerve; Neural Conduction; Sensitivity and Specificity; Ulnar Nerve; Ultrasonography
PubMed: 31185120
DOI: 10.3928/01477447-20190604-02 -
Asian Journal of Surgery Jun 2020Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of...
BACKGROUND
Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of carpal tunnel syndrome. Recently, studies have aimed to diagnose carpal tunnel syndrome through ultrasound or MRI. The purpose of this study was to compare and analyze the cross-sectional area of the median nerve between patients with carpal tunnel syndrome and a control group.
METHODS
From July 2015 to August 2017, we retrospectively analyzed fishery and white-collar workers (164 people, 37 men, 127 women). Carpal tunnel syndrome was diagnosed on the basis of both physical examination and nerve conduction testing. A negative result in either test led to exclusion from the study.
RESULTS
In total, 164 wrist MRI were retrieved, with 67 patients diagnosed with carpal tunnel syndrome and 97 patients allocated to the control group. The mean value of cross-sectional area at the pisiform was 18.8 mm in the MRI of the carpal tunnel syndrome patients and 12.1 mm (p-value <0.05) in the control group. The mean value of cross-sectional area at the hook of hamate was 11.70 mm and that at the control group was 11.67 mm (p-value 0.055).
CONCLUSION
Cross-sectional area at pisiform in MRI is a valuable factor in the diagnosis of carpal tunnel syndrome and in predicting the duration of pain.
Topics: Aged; Carpal Tunnel Syndrome; Female; Hamate Bone; Humans; Magnetic Resonance Imaging; Male; Median Nerve; Middle Aged; Neural Conduction; Pain; Physical Examination; Retrospective Studies
PubMed: 31473048
DOI: 10.1016/j.asjsur.2019.08.001 -
SAGE Open Medical Case Reports 2022Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor...
Closed rupture of a flexor profundus tendon to the little finger caused by asymptomatic pisotriquetral osteoarthritis: A case required differentiation from the tendon rupture due to hamate bony irregularity by bone erosion.
Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor profundus tendon closed rupture of the little finger due to asymptomatic pisotriquetral osteoarthritis in a 73-year-old woman, which required differentiation from tendon rupture due to hamate bony irregularity due to bone erosion. Computed tomography showed cortical bone irregularities of the hamate and the narrowing of the pisotriquetral joint space, and a bony spur on the radial side of the pisiform. Intraoperative findings revealed the capsule of the pisotriquetral joint was torn on the radial side. Pisiform-hamate ligament disruption and the bony spur on the pisiform were found on this side. However, the flexor tendon floor on the hamate was intact. Surgical resection of the pisiform and a free tendon interposition graft for tendon rupture restored the good function of the little finger. Particular attention should be paid in making the diagnosis in cases with multiple possible triggers for closed flexor tendon rupture.
PubMed: 35747244
DOI: 10.1177/2050313X221104314