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.
Two months after a peroneal fracture the x-rays show a regular healing but the patient feels pain: why?
I suggest you to always use both ultrasound and Mri imaging to better evaluate the correct healing of the fracture.
In this professional football player is also evident a gross perilesional edema involving the peroneal muscles togheter with the peroneal neurovascular bundle.
Axial T2w (left) and Stir (right) mri sequences of the same patient (0.3 Tesla).
Sagittal Stir (left) and T2w (right) Mri sequences (0.3 Tesla); the perilesional edema along the course of peroneal neurovascular bundle is evident.
The dynamic ultrasound exam allows to better appreciate all the structures involved in this pathological picture; just a little reminder: high sensibility but 0% specificity of the ultrasound imaging in the study of cortical bone.