about dynamic mri and ultrasound examination of carpal instability
In my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament I showed the usefulness of both ultrasound and Mri dynamic evaluation in the study of this important ligament structure. Today I want to show you the dorsal scapholunate ligament (SL) tear in a patient that came to my observation after a regular healing of post-traumatic scaphoid fracture.
Coronal Stir (left) and T1w (right) Mri scans (0.3 Tesla): correct visualization with no artifacts of post-surgical treatment with scaphoid screw. Tear of the dorsal scapholunate ligament is evident (red arrow).
For the appropriate treatment is crucial to see also the dynamic behaviour of this kind of injuries. I always perform both ultrasound and Mri dynamic evaluation in these cases.
The dynamic ultrasound exam shows the post-traumatic carpal instability; dorsal SL tear is evident, togheter with the scapholunate dissociation and DISI picture.
The Dynamic Mri evaluation (0.3 Tesla) during flexion-extension and ulnar-radial deviation confirms the clinical picture, better defining all the pathologic findings. The radiology technician plays a crucial role for this kind of examination, explaining to the patient the correct wrist movement during the Mri acquisitions.
About Mri and Ultrasound study of palmar fibromatosis of the hand.
This fibrosing hand disorder often leads to progressive and debilitating flexion contractures of the fingers. The diagnosis is made clinically but defining how much a fibrous nodule infiltrates a tendon is a keyelement in the diagnosis and treatment strategy, especially because recurrence after surgery is common.
For this reason I always perform both Mri and ultrasound examinations in my daily practice. Always.
Sagittal (left) and Axial (right) T2w Mri scans (0.3 Tesla); red arrows indicate the fibrous nodule and flexor tendons.
The video below demonstrates the nodule traction on the underlying flexor tendons, resulting in flexion contractures of the digits (Dupuytren contractures).