Ultrasound guidance for puncture and injection in the radiocarpal joint

The use of intra-articular contrast agent has been shown to increase the diagnostic accuracy of wrist magnetic resonance (MR) in patients with suspected trauma of the wrist ligaments. Traditionally, the contrast agent has been applied under fluoroscopic guidance.

To present a method based on ultrasound guidance for the injection of intra-articular contrast agent in wrist MR.

One hundred eight patients (56 female and 52 male, mean age 36 years) referred for wrist MR arthrograms due to suspected ligament rupture were included in this retrospective study. The preferred injection point is about 1 cm distal to Lister's tubercle in the distal radius. A correct positioning of the injection needle can be ensured using ultrasound guidance.

Using this technique, the injection was intra-articular in 93.5% of the 108 injections over a 2-year learning period.

Ultrasound guidance of the contrast injection in radiocarpal MR arthrograms is a cost-effective and safe alternative to fluoroscopically guided procedures. Furthermore, the use of ultrasound guidance provides clues about possible fluid collections within the joint.