ARTHROGRAPHY OF THE WRIST - ASSESSMENT OF THE INTEGRITY OF THE LIGAMENTS IN YOUNG ASYMPTOMATIC ADULTS

Fifty-two asymptomatic adults who were between twenty and thirty-five years old had arthrography of the wrist with use of a single injection into the radiocarpal joint. The purpose of the study was to evaluate the integrity of the triangular fibrocartilage, the scapholunate ligam ent, and the lunotriquetral ligament. Contrast medium was injected und er fluoroscopic guidance, and posteroanterior and lateral radiographs of the wrist were made after the subjects had performed exercises of t he wrist. No patient who had a history of trauma to the wrist, pain in the wrist, or inflammatory arthritis was included in the study. All o f the subjects had an examination of both upper extremities that inclu ded measurement of the active motion of the wrist with a goniometer, s trength-testing with a Jamar dynamometer, ballottement and testing for impingement, and palpation for tenderness. Plain radiographs were eva luated, and the ulnar variance was recorded. The arthrograms revealed an abnormal communication of the contrast medium in fourteen wrists (2 7 per cent), and four of the fourteen had multiple areas of communicat ion. The abnormal communication was through the triangular fibrocartil age alone in six wrists, the scapholunate ligament alone in two wrists , the lunotriquetral ligament alone in two wrists, and in more than on e of these areas in four wrists. A positive arthrogram was associated with a greater positive ulnar variance. All of the subjects had symmet rical motion of the wrists and grip strength, and none of them had ten derness in the wrist. There were no complications related to the arthr ography. Perforation of a ligament in the wrist is common in young asy mptomatic adults. The usefulness of arthrography of the wrist may be l imited by an apparent lack of specificity with regard to the underlyin g pathological condition. The importance of a positive arthrographic s tudy remains unclear, and if arthrography is used the results should b e correlated with other clinical parameters.