Ulnar-Sided Traumatic Wrist Pain. High Resolution Ultrasound Effectiveness versus MRI Assessment and Accuracy

Abstract

Background: This work was conducted to assess the effectiveness of high resolution Ultrasonography (USG) compared with Magnetic Resonance Imaging (MRI) in investigating causes of ulnar sided wrist pain in traumatic patients, as this entity represents a diagnostic dilemma, owing to the anatomical complexity and small sized structures, as well as diversity of causes. Imaging plays an important role in guiding the diagnosis and minimizing unwanted surgical interventions. Aim of Study:To evaluate the diagnostic performance of both ultrasonography and MRI in ulnar sided wrist pain, highlightening both the strengths and weaknesses of these two imaging modalities.Patients and Methods: This study included fifty patients presenting with ulnar sided wrist pain. MRI and Ultrasonography were done in all patients.Results: Out of 50 patients, 30 males (60%) and 20 females (40%), age ranging 23-65 years, were included in this study. A comparative analysis was done using MRI versus USG findings. The sensitivity, specificity, and accuracy of USG for Scapho-lunate ligament injury were 45.5%, 100%, 88% respectively, as MRI was positive in 11 cases, while USG only diagnosed 5 cases. The sensitivity, specificity, and accuracy for Triangular Fibrocartilage (TFCC) tear, were 64.71%, 90.91% and 82% respectively, as MRI was positive in 17 cases, while USG diagnosed 14 cases. For Extensor Carpi Ulnaris (ECU) injury, were 100%, 89.1% and 92% respectively, as MRI was positive in 13 cases, while USG diagnosed 17 cases. For extensor carpi ulnaris tendon subluxation, were 100%, 100% and 100% respectively, as both modalities were successful in diagnosing the same three cases, for ganglion cysts, were 100%, 100% and 100% respectively. For trabecular bone edema, MRI was positive in 24 cases, and for distal radioulnar joint instability MRI was positive in 9 cases, which were not diagnosed by USG, with lack of agreement between both modalities. Conclusion:Both magnetic resonance imaging and musculoskeletal ultrasound are essential and complement each other in the evaluation of causes of ulnar sided wrist pain in trauma patients. Musculoskeletal ultrasound is highly recommended for the examination of tendon injuries, while MRI is