COMPARISON OF THE FINDINGS OF TRIPLE-INJECTION CINEARTHROGRAPHY OF THE WRIST WITH THOSE OF ARTHROSCOPY

Fifty consecutive patients who had a history and clinical findings con sistent with internal derangement of the wrist were prospectively ente red into a study to compare the findings of triple-injection arthrogra phy with those of arthroscopy of the wrist with use of three portals, Twenty-six patients were men, and twenty-four were women. They had an average age of thirty-six years (range, eighteen to seventy years). Th e average duration of symptoms in the wrist was eight months (range, o ne to twenty-four months), The arthrograms of the wrist, which include d cineradiographs, were all made and evaluated by the same radiologist . The arthroscopic evaluation of the wrists was performed by two hand surgeons who had previous knowledge of the arthrographic findings. The abnormal findings included in this study were limited to those that s hould be detectable with both arthrography and arthroscopy. These were full-thickness tears of the scapholunate Ligament, the lunotriquetral ligament, and the triangular fibrocartilage. The findings of arthrogr aphy were normal in eighteen wrists, demonstrated a single lesion in t wenty-one, and demonstrated multiple lesions in eleven, Twelve wrists were noted to have a tear of the scapholunate ligament; fifteen, a tea r of the lunotriquetral ligament; and eighteen, a tear of the triangul ar fibrocartilage. The arthroscopic findings were normal in six wrists , demonstrated a single lesion in twenty-five, and demonstrated multip le lesions in nineteen. Twenty-two wrists were noted to have a tear of the scapholunate ligament; fifteen, a tear of the lunotriquetral liga ment; and thirty; a tear of the triangular fibrocartilage, When compar ed with arthroscopy of the wrist, the sensitivity, specificity, and ac curacy of triple-injection cinearthrography in detecting tears of the scapholunate ligament, lunotriquetral ligament, and triangular fibroca rtilage, as a group, were 56, 83, and 60 per cent, Although arthrograp hy of the wrist is a well accepted diagnostic modality in the evaluati on of pain in the mist, this study suggests that normal arthrographic findings do not necessarily rule out the possibility of internal deran gement of the wrist.