Wrist arthrogram and extravasation into DRUJ

Case contributed by Dr Dai Roberts

Presentation

Ulna sided wrist pain after fall.

Patient Data

Age: 35 years
Gender: Male

Fluoroscopic image captures are shown during a left wrist arthrogram for ulna sided wrist pain. 

A proximal scaphoid pole technique is used. 

The first run during injection of iodinated contrast confirms an intra-articular position with freely flowly contrast. 

The second run is taken whilst injecting the gadolinium containing arthrogram solution and shows the expected flow throughout the left wrist joint. 

The final capture is taken after the needle has been removed and dynamic movements performed. It shows contrast within the distal radial ulna joint (DRUJ) indicating a triangular fibrocartilage complex (TFCC) tear. 

This coronal T1 fat saturated weighted sequences confirms a perforation of the central TFC disc proper and redemonstrates fluid within the DRUJ.  

Case Discussion

Different arthrogram techniques are used and described and most have similar outcomes.  An important aspect of performing such injections is knowing the correct total volume of injectate to use in each joint.  This should factor in the volume of the iodinated contrast injected, volume within the extension tubing and volume used of the arthrogram solution. 

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Case information

rID: 73346
Published: 8th Jan 2020
Last edited: 8th Jan 2020
Inclusion in quiz mode: Included

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