Imaging of the Wrist and Hand

, Royal Victoria Hospital, McGill University, Montrèal, Canada.


Medscape General Medicine. 1999;1(1) 

In This Article


This noninvasive technique is performed by a radiologist. Its major distinction from plain radiography is that it is dynamic. Fluoroscopy has no role in the acute trauma setting. Although previously utilized on occasion to search for an occult fracture, MRI and/or computerized tomography (CT) are now the imaging techniques of choice. Fluoroscopy remains a useful technique for the detection of abnormal bony motion and ligamentous/capsular damage. Unlike arthrography and MRI, fluoroscopy does not allow direct visualization of the damaged ligament/capsule. Rather, injury to these soft tissue structures can be inferred by the detection of aberrant wrist motion.

Utilizing an instability series, an examination where the ligaments of both wrists are tested during fluoroscopic visualization, injury of the intercarpal and capsular ligaments can be detected (Fig. 12). As with stress views, the contralateral (asymptomatic) side should also be evaluated so that it can serve as a comparison for the symptomatic side. This is again due to the variability in the laxity of ligaments among individuals.

Figure 12. An instability series was performed because of suspected scapholunate diastasis. Posteroanterior view of the right wrist, with the scapholunate joint in profile, demonstrates a gap between the scaphoid and lunate. Posteroanterior radiograph of the hand was normal.

In the trauma setting, an instability series should be performed in those patients with abnormal carpal alignment on conventional four-view wrist exam, or those with scapholunate joint or ligament pain. In addition, patients with reproducible popping and/or clicking of the wrist or those suspected of having abnormal bony motion are ideally evaluated by fluoroscopy with or without videotaping.[9] The latter allows for documentation of abnormal bony motion. An instability series is contraindicated in the presence of an acute fracture, as nondisplaced fractures may be converted to displaced fractures during the procedure.