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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Wrist Arthrogram - StatPearls - NCBI Bookshelf</title>
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<meta name="citation_title" content="Wrist Arthrogram">
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<meta name="citation_date" content="2024/10/14">
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<meta name="citation_author" content="Shady Hermena">
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<meta name="citation_author" content="Mate Zabaglo">
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<meta name="citation_pmid" content="39536148">
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<meta name="DC.Contributor" content="Shady Hermena">
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<meta name="DC.Contributor" content="Mate Zabaglo">
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<meta name="DC.Date" content="2024/10/14">
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<meta name="description" content="Wrist arthrography, first introduced by Kesseler and Silberman in 1961 to assess the carpal ligaments, is a valuable diagnostic modality used to evaluate the internal structures of the wrist.[1] This technique involves injecting contrast material into the wrist joint to enhance visualization during imaging examinations such as plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT). Wrist arthrograms are particularly useful for assessing articular cartilage, ligaments, tendons, joint stability, and functional dynamics.[2] While advanced imaging techniques like MRI have gained prominence, wrist arthrography remains essential for diagnosing ligament tears, triangular fibrocartilage complex injuries, and other wrist pathologies (see Image. Wrist Arthrogram).">
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<meta name="og:description" content="Wrist arthrography, first introduced by Kesseler and Silberman in 1961 to assess the carpal ligaments, is a valuable diagnostic modality used to evaluate the internal structures of the wrist.[1] This technique involves injecting contrast material into the wrist joint to enhance visualization during imaging examinations such as plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT). Wrist arthrograms are particularly useful for assessing articular cartilage, ligaments, tendons, joint stability, and functional dynamics.[2] While advanced imaging techniques like MRI have gained prominence, wrist arthrography remains essential for diagnosing ligament tears, triangular fibrocartilage complex injuries, and other wrist pathologies (see Image. Wrist Arthrogram).">
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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Wrist Arthrogram</div><div class="j">StatPearls [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 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viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK609097_"><span class="title" itemprop="name">Wrist Arthrogram</span></h1><p class="contribs">Hermena S, Zabaglo M.</p><p class="fm-aai"><a href="#_NBK609097_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-143115.s1"><h2 id="_article-143115_s1_">Continuing Education Activity</h2><p>A wrist arthrogram is a diagnostic procedure involving injecting contrast material into the wrist joint to enhance visualization of its internal structures during imaging studies such as plain radiography, computed tomography, or magnetic resonance imaging. This procedure primarily evaluates joint stability, ligaments, tendons, and cartilage in clinical situations characterized by wrist pain, a known injury, or suspected ligament tears. Wrist arthrograms are especially helpful in diagnosing conditions affecting complex structures such as the triangular fibrocartilage complex, scapholunate ligament, and lunotriquetral ligament. This procedure enables the detection of subtle injuries, partial or complete tears, and degenerative changes that may not be visible on standard imaging techniques.</p><p>This activity for healthcare professionals reviews the indications for wrist arthrography, procedural steps, and best practices for image interpretation. The activity also reviews the contraindications and technical aspects of wrist arthrography to enhance the diagnostic accuracy of complex wrist pathologies. The importance of interprofessional collaboration, such as working with radiologists, orthopedic specialists, and rehabilitation therapists, to ensure comprehensive patient care is highlighted.</p><p>
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<ul><li class="half_rhythm"><div>Identify the appropriate indications for performing a wrist arthrogram in patients with wrist pain or suspected ligament injuries.</div></li><li class="half_rhythm"><div>Differentiate between normal and abnormal imaging findings during the interpretation of wrist arthrograms.</div></li><li class="half_rhythm"><div>Screen patients for contraindications to wrist arthrograms, such as allergies to contrast material or active infections.</div></li><li class="half_rhythm"><div>Collaborate with the interprofessional team of radiologists, orthopedic specialists, and rehabilitation professionals to provide comprehensive care for wrist injuries.</div></li></ul>
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<a href="https://www.statpearls.com/account/trialuserreg/?articleid=143115&utm_source=pubmed&utm_campaign=reviews&utm_content=143115" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
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</p></div><div id="article-143115.s2"><h2 id="_article-143115_s2_">Introduction</h2><p>Wrist arthrography, first introduced by Kesseler and Silberman in 1961 to assess the carpal ligaments, is a valuable diagnostic modality used to evaluate the internal structures of the wrist.<a class="bibr" href="#article-143115.r1" rid="article-143115.r1">[1]</a> This technique involves injecting contrast material into the wrist joint to enhance visualization during imaging examinations such as plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT). Wrist arthrograms are particularly useful for assessing articular cartilage, ligaments, tendons, joint stability, and functional dynamics.<a class="bibr" href="#article-143115.r2" rid="article-143115.r2">[2]</a> While advanced imaging techniques like MRI have gained prominence, wrist arthrography remains essential for diagnosing ligament tears, triangular fibrocartilage complex injuries, and other wrist pathologies (see <b>Image.</b> Wrist Arthrogram).</p></div><div id="article-143115.s3"><h2 id="_article-143115_s3_">Anatomy and Physiology</h2><p>
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<b>Bony Structures of the Wrist </b>
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</p><p>The wrist joint is formed by the articulation between the distal end of the radius and the articular disk with the proximal carpal row (excluding the pisiform). The carpal bones create a convex surface that matches the concave configuration of the distal radius and articular disk.<a class="bibr" href="#article-143115.r3" rid="article-143115.r3">[3]</a> The distal ulna does not articulate directly with carpal bones due to the presence of the articular disk. The distal radioulnar joint articulates the distal ulna with the distal radius.<a class="bibr" href="#article-143115.r4" rid="article-143115.r4">[4]</a></p><p>
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<b>Ligaments of the Wrist</b>
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</p><p>The ligamentous attachments of the wrist are crucial for maintaining stability and facilitating coordinated movements.<a class="bibr" href="#article-143115.r5" rid="article-143115.r5">[5]</a> There are 4 main ligaments situated at the wrist joint, each serving distinct functions:</p><ul><li class="half_rhythm"><div>Palmar radiocarpal ligament: located on the volar aspect extending from the radius to both rows of carpal bones. This ligament enhances stability and ensures the synchronization of hand and forearm movements during supination.</div></li><li class="half_rhythm"><div>Dorsal radiocarpal ligament: runs from the radius to both carpal rows on the dorsal aspect of the wrist, contributing to wrist stability and coordinating hand and forearm motions during pronation. </div></li><li class="half_rhythm"><div>Ulnar collateral ligament: extending from the ulnar styloid process to the triquetrum and pisiform, effectively preventing excessive radial deviation of the hand.</div></li><li class="half_rhythm"><div>Radial collateral ligament: connecting the radial styloid process to the scaphoid and trapezium, inhibiting excessive ulnar deviation.<a class="bibr" href="#article-143115.r3" rid="article-143115.r3">[3]</a></div></li></ul><p>
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<b>Triangular Fibrocartilage Complex</b>
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</p><p>The triangular fibrocartilage complex (TFCC) contributes significantly to the stability of the distal radioulnar joints. The TFCC is positioned on the ulnar aspect of the wrist between the ulna and the lunate and triquetrum of the proximal carpal row. The TFCC has an elongated triangular shape with its apex directed towards the radius.<a class="bibr" href="#article-143115.r6" rid="article-143115.r6">[6]</a> The TFCC comprises various ligamentous and fibrocartilaginous components, including the triangular fibrocartilage disc proper and triangular ligament, volar and dorsal radioulnar ligaments, ulnocarpal ligaments (ulnotriquetral, ulnolunate, ulnocapitate), meniscal homologue, ulnar collateral ligament, and the extensor carpi ulnaris tendon sheath.<a class="bibr" href="#article-143115.r7" rid="article-143115.r7">[7]</a> Functionally, the TFCC stabilizes the distal radius ulnar joint, cushions the ulnar carpus, accounts for 20% of axial wrist load, and is a crucial stabilizer for the ulnar carpus.<a class="bibr" href="#article-143115.r8" rid="article-143115.r8">[8]</a><a class="bibr" href="#article-143115.r9" rid="article-143115.r9">[9]</a></p></div><div id="article-143115.s4"><h2 id="_article-143115_s4_">Indications</h2><p>The indications of performing a wrist arthrogram, whether conducted as a single investigation or in a combination of other imaging modalities, include but are not limited to:</p><ul><li class="half_rhythm"><div>Diagnosis of wrist joint degenerative and inflammatory conditions such as osteoarthritis and rheumatoid arthritis </div></li><li class="half_rhythm"><div>Identification of traumatic ligamentous abnormalities in the scapholunate ligament, lunotriquetral ligament, and TFCC <a class="bibr" href="#article-143115.r10" rid="article-143115.r10">[10]</a><a class="bibr" href="#article-143115.r11" rid="article-143115.r11">[11]</a></div></li><li class="half_rhythm"><div>Assessment of wrist joint articular cartilage for osteochondral defects <a class="bibr" href="#article-143115.r12" rid="article-143115.r12">[12]</a></div></li><li class="half_rhythm"><div>Investigation of persistent wrist pain <a class="bibr" href="#article-143115.r13" rid="article-143115.r13">[13]</a></div></li><li class="half_rhythm"><div>Suspected scaphoid fracture nonunion <a class="bibr" href="#article-143115.r14" rid="article-143115.r14">[14]</a></div></li><li class="half_rhythm"><div>Assessment for ulnar abutment <a class="bibr" href="#article-143115.r15" rid="article-143115.r15">[15]</a></div></li></ul></div><div id="article-143115.s5"><h2 id="_article-143115_s5_">Contraindications</h2><p>A wrist arthrogram is generally a well-tolerated diagnostic procedure. However, there are certain contraindications that clinicians should consider before recommending or performing wrist arthrograms. These contraindications include: </p><p>
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<b>Absolute Contraindications</b>
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</p><ul><li class="half_rhythm"><div>Previous allergic reactions to contrast material: A known allergy to the contrast material (usually iodine-based contrast agents) used in the arthrogram should preclude the procedure.</div></li><li class="half_rhythm"><div>Presence of an active infection: An active infection around the wrist joint can spread. For example, injecting contrast material through infected skin can lead to septic arthritis due to the deeper spreading of the infection.</div></li></ul><p>
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<b>Relative Contraindications</b>
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</p><ul><li class="half_rhythm"><div>Renal dysfunction: Patients with significant renal dysfunction may be at risk for contrast-induced nephropathy. The contrast dose needs to be adjusted accordingly.</div></li><li class="half_rhythm"><div>Coagulopathies: Individuals with bleeding disorders or those taking anticoagulant medications may be at an increased risk of bleeding complications during or after the arthrogram. In such cases, careful consideration and potential modification of medication regimens may be necessary.</div></li><li class="half_rhythm"><div>Uncontrolled diabetes: Uncontrolled diabetes may increase the risk of contrast-induced complications, and healthcare professionals may need to assess and manage the patient's diabetic status before proceeding with the arthrogram.</div></li><li class="half_rhythm"><div>Pregnancy: Pregnancy is generally considered a relative contraindication, and the risks and benefits of the procedure must be carefully weighed. Radiation exposure from imaging studies, such as x-rays, should be minimized during pregnancy.</div></li></ul><p>Before recommending a wrist arthrogram, healthcare professionals must thoroughly assess the patient's medical history, current health status, and potential contraindications. In cases where contraindications are present, alternative diagnostic approaches or modifications to the procedure may be considered to ensure patient safety.</p></div><div id="article-143115.s6"><h2 id="_article-143115_s6_">Equipment</h2><p>The equipment required for performing a wrist arthrogram includes the components for injection of the local anesthesia and the contrast material into the wrist joint. This includes: </p><ul><li class="half_rhythm"><div>Sterile drapes</div></li><li class="half_rhythm"><div>Local antiseptic solutions</div></li><li class="half_rhythm"><div>Blunt wide bore needle to withdraw the local anesthesia and contrast solutions</div></li><li class="half_rhythm"><div>Sharp fine needle to access the joint for injections</div></li><li class="half_rhythm"><div>3-mL syringes for contrast solution injection</div></li><li class="half_rhythm"><div>10-mL syringe for the local anesthetic solution preparation and injection</div></li><li class="half_rhythm"><div>Contrast agents, gadolinium or iodine-based</div></li></ul><p>Due to its fast-acting anesthetic effect, 1% lidocaine is commonly used for local anesthesia. Lidocaine can be combined with a sodium bicarbonate solution as a buffering agent to minimize irritation caused by the acidic nature of the local anesthetic; this can be achieved by adding approximately 0.5 mL of sodium bicarbonate to 10 mL of 1% lidocaine. An emergency resuscitation cart should be accessible for use in case of an anaphylactic reaction to any of the injected materials.</p></div><div id="article-143115.s7"><h2 id="_article-143115_s7_">Technique or Treatment</h2><p>Informed consent must be obtained before performing wrist arthrography, and contraindications such as infection and contrast allergies should be ruled out before beginning the procedure. The patient is positioned supine on a fluoroscopy table with the wrist in a neutral position. The skin over the wrist is prepped with antiseptic, and an aseptic technique is employed to inject contrast. The injection is ideally performed from the side opposite to the wrist symptoms. For example, injection from the lateral side of ulnar wrist pain allows better differentiation between iatrogenic contrast leakage and leakage due to a capsular tear. Typically, contrast is injected into the joint under imaging guidance, often using an image intensifier.<a class="bibr" href="#article-143115.r15" rid="article-143115.r15">[15]</a></p><p>Wrist arthrography can be performed for 1 compartment (radiocarpal), 2 compartments (radiocarpal and midcarpal or radiocarpal and distal radioulnar), or more commonly for 3 compartments (radiocarpal, midcarpal, and distal radioulnar compartments).<a class="bibr" href="#article-143115.r16" rid="article-143115.r16">[16]</a><a class="bibr" href="#article-143115.r17" rid="article-143115.r17">[17]</a> To inject contrast into the midcarpal compartment, the space between the scaphoid and capitate or between the triquetrum and hamate is targeted. This allows contrast to flow into the scapholunate and lunotriquetral spaces. If the intrinsic ligaments between the scaphoid, lunate, and triquetrum are intact, the contrast will not flow into the radiocarpal joint. For contrast injection into the radiocarpal compartment from the ulnar side, the target is the space between the radial side of the pisiform and the proximal triquetrum. Injection from the radial side involves the space between the styloid process and the proximal pole of the scaphoid. The radial margin of the ulnar head is targeted to inject the distal radioulnar joint.<a class="bibr" href="#article-143115.r15" rid="article-143115.r15">[15]</a></p></div><div id="article-143115.s8"><h2 id="_article-143115_s8_">Complications</h2><p>Complications associated with wrist arthrogram may include:</p><ul><li class="half_rhythm"><div><b>Allergic Reactions</b>
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<ul><li class="half_rhythm"><div>Some patients may develop allergic reactions to the contrast material used in the procedure. This is more common with iodine-based contrast agents.</div></li><li class="half_rhythm"><div>Adverse allergic reactions can range from mild skin irritation to severe anaphylaxis.</div></li></ul>
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</div></li><li class="half_rhythm"><div><b>Septic Arthritis</b>
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<ul><li class="half_rhythm"><div>There is a risk of introducing an intraarticular infection during the wrist arthrogram, particularly if aseptic techniques are not followed.</div></li><li class="half_rhythm"><div>Infections can present as local swelling, redness, pain, and systemic symptoms such as fever and sepsis.</div></li><li class="half_rhythm"><div>If the diagnosis of septic arthritis is confirmed, an urgent surgical wrist joint washout is mandatory to preserve the joint cartilage and prevent systemic sepsis. </div></li></ul>
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</div></li><li class="half_rhythm"><div><b>Bleeding: </b>Bleeding at the injection site or within the joint may occur, especially in individuals with bleeding disorders or those taking anticoagulant medications. Clinicians may consider the benefits and risks of stopping anticoagulant treatment before wrist arthrogram. </div></li><li class="half_rhythm"><div><b>False-Positive Findings: </b>Accidental gas injection during the performance of a wrist arthrogram can result in a false-positive diagnosis of loose intraarticular bodies, leading to misinterpretation of the diagnostic imaging results.</div></li><li class="half_rhythm"><div><b>Sterile Chemical Synovitis</b>
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<ul><li class="half_rhythm"><div>Postarthrography pain, often resulting from sterile chemical synovitis, is the most common complication of wrist arthrography.</div></li><li class="half_rhythm"><div>The introduction of contrast material causes an inflammatory reaction within the wrist joint. Symptoms typically begin about 4 hours postprocedure and peak at around 12 hours. Despite the absence of infection—hence the term "sterile"—the contrast agent's chemical irritant properties can inflame the synovial lining, causing pain, swelling, and discomfort.</div></li><li class="half_rhythm"><div>This complication can mimic septic arthritis, requiring close monitoring and management by healthcare professionals to ensure accurate diagnosis and treatment.<a class="bibr" href="#article-143115.r18" rid="article-143115.r18">[18]</a></div></li></ul>
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</div></li><li class="half_rhythm"><div><b>Nerve or Vascular Injury: </b>In rare cases, the needle used for the injection may inadvertently damage nearby nerves or blood vessels, leading to neurological or vascular complications.</div></li><li class="half_rhythm"><div><b>Intraarticular Structures Damage: </b>There is a small risk of causing damage to the joint structures during the injection, particularly if there are preexisting joint abnormalities or pathology.</div></li><li class="half_rhythm"><div><b>Pain or Discomfort: </b>Some patients may experience temporary pain or discomfort at the injection site or within the joint, usually mild and short-lived.</div></li><li class="half_rhythm"><div><b>Radiation Exposure: </b>If x-rays are used during the procedure, there is potential for radiation exposure. While the amount of radiation is generally low, it is a consideration, particularly for pregnant patients. Healthcare professionals should take the necessary precautions to minimize risks and follow safety protocols.</div></li></ul></div><div id="article-143115.s9"><h2 id="_article-143115_s9_">Clinical Significance</h2><p>The wrist arthrogram is a valuable diagnostic tool for evaluating intraarticular pathology and structural abnormalities within the wrist joint, including:</p><p>
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<b>TFCC Tears</b>
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</p><p>The TFCC serves as a critical stabilizer for the lunate, triquetrum, and ulnar head while also functioning as a load-bearing structure on the ulnar side of the wrist. Injuries to the TFCC are commonly associated with activities that involve forced ulnar deviation or positive ulnar variance. Such injuries often occur when pressure is applied to the TFCC during wrist movements like wielding a racket, swinging a bat, or in cases of trauma such as falling on an outstretched hand or hyperextension injuries.<a class="bibr" href="#article-143115.r9" rid="article-143115.r9">[9]</a><a class="bibr" href="#article-143115.r10" rid="article-143115.r10">[10]</a><a class="bibr" href="#article-143115.r19" rid="article-143115.r19">[19]</a></p><p>Conventional MRI scans can struggle to differentiate between degenerative and traumatic TFCC tears due to their limited sensitivity and specificity.<a class="bibr" href="#article-143115.r20" rid="article-143115.r20">[20]</a><a class="bibr" href="#article-143115.r21" rid="article-143115.r21">[21]</a><a class="bibr" href="#article-143115.r22" rid="article-143115.r22">[22]</a> However, combining MRI with an arthrogram (MR arthrography) significantly enhances diagnostic accuracy, with reported sensitivity and specificity rates of 97.1% and 96.4%, respectively, for identifying partial and complete TFCC tears.<a class="bibr" href="#article-143115.r23" rid="article-143115.r23">[23]</a> In MR arthrography, TFCC perforations appear as areas of high signal intensity on fat-suppressed T1-weighted images, and contrast material may also be visualized in the distal radioulnar joint in cases of traumatic TFCC injury.<a class="bibr" href="#article-143115.r24" rid="article-143115.r24">[24]</a></p><p>
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<b>Scapholunate Ligament Injury and Scapholunate Instability</b>
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</p><p>Scapholunate ligament injury has the highest incidence of wrist ligament injuries. In advanced cases, injury of the scapholunate ligament can result in progressive scaphoid flexion, widening the articulation between the scaphoid and lunate bones in wrist anteroposterior radiographs. If a single compartment arthrogram is performed for the radiocarpal compartment and the contrast is identified in the midcarpal compartment, this is a sign of scapholunate ligament disruption. MR arthrography is more sensitive than MRI for detecting scapholunate ligament injuries' exact location and extension.<a class="bibr" href="#article-143115.r15" rid="article-143115.r15">[15]</a></p><p>
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<b>Midcarpal Instability</b>
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</p><p>These rare injuries involve disruption of the ligaments between the distal and proximal carpal row bones while the proximal row ligaments stay intact. MR arthrography has higher sensitivity in assessing each ligament and the exact extension of injury.<a class="bibr" href="#article-143115.r15" rid="article-143115.r15">[15]</a></p><p>
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<b>Distal Radioulnar Joint Abnormalities</b>
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</p><p>The wrist arthrogram allows further assessment of articular cartilage at the distal radioulnar joint and the joint capsule for any signs of tears or synovitis.<a class="bibr" href="#article-143115.r25" rid="article-143115.r25">[25]</a></p></div><div id="article-143115.s10"><h2 id="_article-143115_s10_">Enhancing Healthcare Team Outcomes </h2><p>Performing and interpreting a wrist arthrogram involves a collaborative effort among healthcare professionals, necessitating a spectrum of skills, strategic planning, ethical considerations, shared responsibilities, effective interprofessional communication, and meticulous care coordination to optimize patient-centered care, enhance outcomes, ensure patient safety, and improve team performance. Physicians must comprehensively understand wrist anatomy, pathology, and the diagnostic implications of wrist arthrogram. Advanced clinicians, including radiologists, need specialized skills in performing the procedure, ensuring accurate contrast injection, and interpreting imaging results. Nurses are crucial in preparing patients for the arthrogram, providing care before and after the procedure, and monitoring potential complications. Pharmacists contribute by ensuring appropriate contrast agents and medications and managing drug-related concerns.</p><p>Ethical considerations involve obtaining informed consent, ensuring patient privacy, and communicating clearly about the procedure and potential outcomes. Team members share responsibilities, with each professional contributing expertise to the overall patient care plan. Interprofessional communication is paramount to ensure that all team members are aligned in understanding the patient's condition, the purpose of the wrist arthrogram, and the subsequent care plan. This collaborative approach helps address concerns, share critical information, and foster a cohesive team dynamic. Care coordination involves scheduling appointments, communicating results among team members, and ensuring that the patient receives appropriate follow-up care, which is essential for a seamless patient experience. This coordinated effort enhances patient-centered care, contributes to positive outcomes, and reduces the risk of errors or oversights.</p></div><div id="article-143115.s11"><h2 id="_article-143115_s11_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div class="floats-group" id="article-143115.s12"><div class="iconblock whole_rhythm clearfix ten_col fig" id="figarticle143115imagef1" co-legend-rid="figlgndarticle143115imagef1"><a href="/books/NBK609097/figure/article-143115.image.f1/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figarticle143115imagef1" rid-ob="figobarticle143115imagef1"><img class="small-thumb" src="/books/NBK609097/bin/wrist__arthrogram.gif" src-large="/books/NBK609097/bin/wrist__arthrogram.jpg" alt="Wrist Arthrogram" /></a><div class="icnblk_cntnt" id="figlgndarticle143115imagef1"><h4 id="article-143115.image.f1"><a href="/books/NBK609097/figure/article-143115.image.f1/?report=objectonly" target="object" rid-ob="figobarticle143115imagef1">Figure</a></h4><p class="float-caption no_bottom_margin">Wrist Arthrogram. The arthrogram shows an accumulation of contrast material on the ulnar side of the wrist joint, suggestive of a triangular fibrocartilage complex (TFCC) injury. Notably, there is no contrast leakage into the mid-carpal space or the distal <a href="/books/NBK609097/figure/article-143115.image.f1/?report=objectonly" target="object" rid-ob="figobarticle143115imagef1">(more...)</a></p></div></div></div><div id="article-143115.s13"><h2 id="_article-143115_s13_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-143115.r1">KESSLER I, SILBERMAN Z. An experimental study of the radiocarpal joint by arthrography. <span><span class="ref-journal">Surg Gynecol Obstet. </span>1961 Jan;<span class="ref-vol">112</span>:33-40.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/13752749" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 13752749</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-143115.r2">Maloney E, Zbojniewicz AM, Nguyen J, Luo Y, Thapa MM. Anatomy and injuries of the pediatric wrist: beyond the basics. <span><span class="ref-journal">Pediatr Radiol. </span>2018 Jun;<span class="ref-vol">48</span>(6):764-782.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29557490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29557490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="article-143115.r3">Erwin J, Varacallo MA. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Sep 4, 2023. Anatomy, Shoulder and Upper Limb, Wrist Joint. [<a href="https://pubmed.ncbi.nlm.nih.gov/30521200" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30521200</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="article-143115.r4">Lewis OJ, Hamshere RJ, Bucknill TM. The anatomy of the wrist joint. <span><span class="ref-journal">J Anat. </span>1970 May;<span class="ref-vol">106</span>(Pt 3):539-52.</span> [<a href="/pmc/articles/PMC1233428/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1233428</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/4987391" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4987391</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="article-143115.r5">Taleisnik J. The ligaments of the wrist. <span><span class="ref-journal">J Hand Surg Am. </span>1976 Sep;<span class="ref-vol">1</span>(2):110-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1018078" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1018078</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="article-143115.r6">Nakamura T, Takayama S, Horiuchi Y, Yabe Y. Origins and insertions of the triangular fibrocartilage complex: a histological study. <span><span class="ref-journal">J Hand Surg Br. </span>2001 Oct;<span class="ref-vol">26</span>(5):446-54.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11560427" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11560427</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="article-143115.r7">Martins T, Marappa-Ganeshan R. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 31, 2023. Anatomy, Shoulder and Upper Limb, Forearm Triangular Fibrocartilage Complex. [<a href="https://pubmed.ncbi.nlm.nih.gov/32119451" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32119451</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="article-143115.r8">Palmer AK. Triangular fibrocartilage complex lesions: a classification. <span><span class="ref-journal">J Hand Surg Am. </span>1989 Jul;<span class="ref-vol">14</span>(4):594-606.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2666492" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2666492</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="article-143115.r9">Casadei K, Kiel J. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Aug 14, 2023. Triangular Fibrocartilage Complex. [<a href="https://pubmed.ncbi.nlm.nih.gov/30725740" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30725740</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="article-143115.r10">Mirza A, Mirza JB, Zappia LC, Thomas TL. Ulnar-Sided Wrist Pain: A Diagnostic Evaluation Guide From 30-Plus Years of Experience. <span><span class="ref-journal">Cureus. </span>2024 Jan;<span class="ref-vol">16</span>(1):e53332.</span> [<a href="/pmc/articles/PMC10907076/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10907076</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/38435942" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 38435942</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="article-143115.r11">Fransson SG. Wrist arthrography. <span><span class="ref-journal">Acta Radiol. </span>1993 Mar;<span class="ref-vol">34</span>(2):111-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8452713" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8452713</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="article-143115.r12">Nischal N, Iyengar KP, Herlekar D, Botchu R. Imaging of Cartilage and Chondral Defects: An Overview. <span><span class="ref-journal">Life (Basel). </span>2023 Jan 28;<span class="ref-vol">13</span>(2)</span> [<a href="/pmc/articles/PMC9960762/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9960762</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36836719" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36836719</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="article-143115.r13">Cooney WP. Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy. <span><span class="ref-journal">J Hand Surg Am. </span>1993 Sep;<span class="ref-vol">18</span>(5):815-22.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8228051" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8228051</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="article-143115.r14">Crema MD, Phan C, Miquel A, Quach C, Arrivé L, Menu Y. MDCT arthrography assessment of scaphoid nonunion advanced collapse: distribution of cartilage damage and relationship with scaphoid nonunion features. <span><span class="ref-journal">Skeletal Radiol. </span>2018 Aug;<span class="ref-vol">47</span>(8):1157-1165.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29520536" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29520536</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-143115.r15">Cerezal L, Abascal F, García-Valtuille R, Del Piñal F. Wrist MR arthrography: how, why, when. <span><span class="ref-journal">Radiol Clin North Am. </span>2005 Jul;<span class="ref-vol">43</span>(4):709-31, viii.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15893533" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15893533</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-143115.r16">Zinberg EM, Palmer AK, Coren AB, Levinsohn EM. The triple-injection wrist arthrogram. <span><span class="ref-journal">J Hand Surg Am. </span>1988 Nov;<span class="ref-vol">13</span>(6):803-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3225404" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3225404</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-143115.r17">Kim S, Lee GY, Lee JS. Evaluation of the triangular fibrocartilage: comparison of two-compartment wrist CT arthrography using the distal radioulnar and radiocarpal joints and unicompartment wrist CT arthrography using the radiocarpal joint. <span><span class="ref-journal">Br J Radiol. </span>2019 Oct;<span class="ref-vol">92</span>(1102):20190298.</span> [<a href="/pmc/articles/PMC6774601/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6774601</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31295006" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31295006</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="article-143115.r18">Oserowsky A, Layfield LJ, Crim J. Post-arthrogram synovitis: MRI and histopathologic findings. <span><span class="ref-journal">Skeletal Radiol. </span>2022 Jan;<span class="ref-vol">51</span>(1):219-223.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34331550" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34331550</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="article-143115.r19">Dunn JC, Polmear MM, Nesti LJ. Surgical Repair of Acute TFCC Injury. <span><span class="ref-journal">Hand (N Y). </span>2020 Sep;<span class="ref-vol">15</span>(5):674-678.</span> [<a href="/pmc/articles/PMC7543220/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7543220</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30762446" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30762446</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="article-143115.r20">Haims AH, Schweitzer ME, Morrison WB, Deely D, Lange R, Osterman AL, Bednar JM, Taras JS, Culp RW. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. <span><span class="ref-journal">AJR Am J Roentgenol. </span>2002 Feb;<span class="ref-vol">178</span>(2):419-22.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11804907" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11804907</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="article-143115.r21">Ng WHA, Griffith JF, Ng ISH. How to Report: Wrist MRI. <span><span class="ref-journal">Semin Musculoskelet Radiol. </span>2021 Oct;<span class="ref-vol">25</span>(5):670-680.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34861712" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34861712</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="article-143115.r22">Daunt N, Couzens GB, Cutbush K, Green J, Ross M. Accuracy of magnetic resonance imaging of the wrist for clinically important lesions of the major interosseous ligaments and triangular fibrocartilage complex; correlation with radiocarpal arthroscopy. <span><span class="ref-journal">Skeletal Radiol. </span>2021 Aug;<span class="ref-vol">50</span>(8):1605-1616.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33474588" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33474588</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="article-143115.r23">Schmitt R, Christopoulos G, Meier R, Coblenz G, Fröhner S, Lanz U, Krimmer H. [Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients]. <span><span class="ref-journal">Rofo. </span>2003 Jul;<span class="ref-vol">175</span>(7):911-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12847645" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12847645</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="article-143115.r24">Jain DKA, Wahegaonkar AL. Ulnar-Side Wrist Pain Management Guidelines: All That Hurts is Not the TFCC! <span><span class="ref-journal">Indian J Orthop. </span>2021 Apr;<span class="ref-vol">55</span>(2):310-317.</span> [<a href="/pmc/articles/PMC8046677/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8046677</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33927808" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33927808</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="article-143115.r25">Gilula LA, Hardy DC, Totty WG. Distal radioulnar joint arthrography. <span><span class="ref-journal">AJR Am J Roentgenol. </span>1988 Apr;<span class="ref-vol">150</span>(4):864-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3258101" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3258101</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Shady Hermena declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Mate Zabaglo declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK609097_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Shady Hermena</span><sup>1</sup>; <span itemprop="author">Mate Zabaglo</span>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Ninewells Hospital , Dundee, Scotland</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">October 14, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Hermena S, Zabaglo M. Wrist Arthrogram. [Updated 2024 Oct 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="fig" id="figobarticle143115imagef1"><div id="article-143115.image.f1" class="figure bk_fig"><div class="graphic"><img data-src="/books/NBK609097/bin/wrist__arthrogram.jpg" alt="Wrist Arthrogram" /></div><div class="caption"><p>Wrist Arthrogram. The arthrogram shows an accumulation of contrast material on the ulnar side of the wrist joint, suggestive of a triangular fibrocartilage complex (TFCC) injury. Notably, there is no contrast leakage into the mid-carpal space or the distal radioulnar joint. Contributed by D Tafti, MD</p></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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