Summary: Focusing on contrast compartmentalization helps pinpoint full-thickness ligamentous and TFCC tears, pivoting away from small-joint pitfalls.
Small Joint, Big Problem: It’s a two-part question in single-joint wrist arthrography: where is contrast supposed to be, versus where is it not? As Dr. Joseph A. Delic reminded us during ARRS26, fluoroscopy doesn’t merely confirm needle placement; it directly aids decision-making for subsequent MRI sequences.
Strict Boundaries: In a normal single-joint radiocarpal injection, contrast remains entirely confined within the radiocarpal joint.
- Normality in sequence shows zero contrast extension through the scapholunate or lunotriquetral intervals, and no contrast leaking into the distal radioulnar joint (DRUJ).
Interval Training: Linear contrast extending through the scapholunate interval indicates a full-thickness ligament tear. When tears involve the dorsal band, volar band, and membranous segment, contrast insinuates throughout the proximal and distal carpal rows.
- Contrast extending into the DRUJ during injection would suggest a full-thickness TFCC central disc tear.
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