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J Wrist Surg 2019; 08(06): 497-502
DOI: 10.1055/s-0039-1697022
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Utility of Specialized Imaging for Diagnosis of Chronic Wrist Pain

Stephanie C. Dreckmann
1   Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
2   Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
,
Herbert P. von Schroeder
1   Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
2   Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
3   Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
,
Christine B. Novak
1   Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
2   Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
,
Heather L. Baltzer 
1   Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
2   Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
› Institutsangaben
Weitere Informationen

Publikationsverlauf

14. November 2018

06. August 2019

Publikationsdatum:
24. September 2019 (online)

    Lizenzen und Reprints

Abstract

Background Patients with chronic wrist pain often undergo imaging (such as magnetic resonance imaging [MRI], computed tomography [CT], or ultrasound [US]) prior to specialist assessment.

Questions Is specialized wrist imaging performed prior to expert consultation necessary? Are there demographic differences between patients who do or do not receive preconsultation imaging?

Patients and Methods A total of 115 patients referred to a tertiary hand center for chronic wrist pain and assessed by a hand surgeon were included. At initial consultation, surgeons were blinded to referral information and previous imaging results. The specialist performed a history, physical examination and reviewed X-rays. They established a clinical diagnosis and whether any additional investigations were needed. Prior MRI, CT, and/or US results were then reviewed and the specialists' clinical diagnosis was compared with the blinded referral diagnosis. Preconsultation imaging was categorized as having no value for diagnosis/management, some value, or high value.

Results A total of 82 patients had imaging prior to specialist referral (69 MRIs, 11 CTs, and 16 ultrasounds). The majority of additional imaging (73%) was classified as unnecessary, including 77% of the MRIs and 100% of the ultrasounds. Of all the investigations performed, two CT scans were labeled highly valuable clinical aids. Older patients and those with radial-sided pain were less likely to receive preconsultation imaging. Six patients required further imaging after consultation.

Conclusion Clinical assessment and X-rays are typically sufficient for a hand specialist to diagnose and manage chronic wrist pain and few patients require additional imaging.

Level of Evidence This is a Level III study.

Keywords

computed tomography - imaging - magnetic resonance imaging - ultrasound - wrist pain - diagnostic tests
 

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