Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain

To determine the significance of arthrographic abnormalities in patients with unilateral wrist pain, the authors compared the prevalence and site of intra-articular ligament perforation in asymptomatic and symptomatic wrists of the same group of patients and correlated asymptomatic perforation with age, hand dominance and hand overuse. Thirty-seven patients (29 men and 8 women ranging in age from 19 to 61 years) who had unilateral wrist pain and positive arthrographic findings for the symptomatic wrist underwent radiocarpal arthrography of the asymptomatic wrist. Three radiologists blinded as to the clinical findings examined the images for perforation in the triangular fibrocartilage complex, the lunotriquetral ligament and the scapholunate ligament. Intra-articular ligament perforations were found in 33 (89%) of the 37 asymptomatic wrists. Seventeen (46%) of the 37 patients had symmetric sites of perforation in the two wrists. Perforation of the triangular fibrocartilage complex occurred in 22 (59%) and 19 (51%) of the symptomatic and asymptomatic wrists respectively, of the lunotriquetral ligament in 13 (35%) and 7 (19%) respectively and of the scapholunate ligament in 13 (35%) and 11 (30%) respectively. No significant correlation between asymptomatic perforation and age or hand overuse was found (chi 2 test, Fisher's exact test). The authors conclude that asymptomatic perforation is common, even in young patients, so ligament perforation is not necessarily the cause of wrist pain in patients with such pain. However, for patients with the appropriate clinical findings, arthrography can be used to confirm or exclude ligament perforation.