Cross-sectional imaging of internal derangement of the wrist with arthroscopic correlation

Wrist arthroscopy has become an indispensable tool for the surgeon treating internal derangement of the wrist. The role of arthroscopy in both the diagnosis and treatment of intrinsic ligaments and triangular fibrocartilage complex (TFCC) pathology is well established. Arthroscopy remains a surgical procedure with potential complications, and it does not obviate the need for a careful history, physical examination, and conventional radiography. When the diagnosis remains unclear after these initial investigations, cross-sectional imaging studies play a valuable role in the assessment of internal derangement of the wrist. These studies include magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography arthrography (CTA), the choice of which depends on the specific clinical query. The radiologist must have exact knowledge of the performance of each diagnostic test to select the appropriate one and interpret it in a clinically relevant manner. With continued refinements in the technological aspects of cross-sectional imaging, its potential to replace diagnostic arthroscopy will surely be realized in the near future. This article focuses on the role of cross-sectional imaging and arthroscopy in the evaluation and management of wrist internal derangement, namely of intrinsic ligaments and TFCC pathology.