Marc Mespreuve

Imaging Findings of the Distal Radio-Ulnar Joint in Trauma

Traumatic lesions of the distal radio-ulnar joint (DRUJ) occur frequently in conjunction with fractures of the distal radius. They are a common cause of pain and limited range of motion after distal radial fractures. Due to the complex anatomy they are however often ignored or underappreciated. Distal radial fractures and luxations of the DRUJ often disturb the normal curvature of the radial notch and cause damage to the cartilage of this joint. The growth of the radius may be disrupted, resulting in a positive ulnar variance, and possibly give rise to complications such as ulnar abutment and motion restriction. Ulnar styloid fractures – sometimes barely visible on plain film – may give rise to symptomatic bony pseudarthrosis, dislocation and laceration of the tendon of the m. extensor carpi ulnaris and a rare posttraumatic deformity of the ulnar epiphysis. Also the possibility of lesions at the adjacent triangular fibrocartilage complex and the joint capsule should be kept in mind. This paper presents a pictorial review of the complex functional anatomy and pathologic conditions of this joint and emphasises why the DRUJ should be evaluated independently and thoroughly. The merit of each imaging modality is mentioned. A correction article relating to Fig. 2 and Fig. 27 can be found here: http://dx.doi.org/10.5334/jbr-btr.966

MRI diagnosis of carpal boss and comparison with radiography

Background A carpal boss is a potentially painful bony mass in the region of the second or third carpometacarpal joint. The combination of clinical examination and radiography is usually sufficient for the diagnosis. Purpose To determine whether magnetic resonance imaging (MRI) examination of the quadrangular joint can assist the diagnosis of persistent pain near a carpal boss. Material and Methods Fifty-seven patients with a carpal boss were retrospectively reviewed using MRI and conventional radiographs and compared to an asymptomatic control group. Results MRI demonstrated a variable morphology and a variety of bone and soft tissue abnormalities associated with carpal boss. Bone marrow edema around the quadrangular joint shows a significant correlation (Fishers exact test: P < 0.001) and a positive correlation (Pearsons test r = 0.632, significant at the 0.01 level [two-tailed]) with a painful carpal boss. Conclusion MRI offers detailed examination of bone and soft tissue abnormalities associated with a carpal boss. Local bone marrow edema strongly correlates with a painful carpal boss.

Lunotriquetral coalition, a normal variant that may rarely cause ulnar sided wrist pain

Lunotriquetral coalition (LTC), the most frequent and often bilateral type of carpal coalition, is in general considered as asymptomatic. In rare cases - however - fibrocartilaginous LTC may be an uncommon cause of ulnar sided pain in the wrist due to the pseudarthrosis or a post-traumatic disruption of LTC. Two rare cases of symptomatic LTC are presented and the role of MRI is emphasized. MRI shows the pseudarthrosis and may additionally show bone marrow edema and subcortical cysts. In symptomatic cases surgical lunotriquetral fusion may be considered as treatment option.

Accessory muscles of the extremities

Abstract Accessory muscles and variations are not uncommon at the upper and lower extremity. They are often overlooked because they are asymptomatic and present as incidental findings on imaging. However, they may present as a soft tissue swelling, thereby mimicking soft tissue tumors. Other symptoms are attributed to impingement on neurovascular structures and to exercise‐related pain. Thorough knowledge of the anatomy, systematic imaging analysis, and the awareness of it are the clues to correct identification. On ultrasound, accessory muscles have a similar echotexture as other muscles, whereas the signal intensity on magnetic resonance imaging (MRI) is similar to muscle. Because of the intrinsic contrast with the adjacent intermuscular fat, accessory muscles are best depicted on MRI without fat suppression. This article provides a short overview of the anatomy of most prevalent accessory muscles of the upper and lower limb and its potential pathogenic nature.

Secondary Abutment Syndromes of the Wrist in Trauma: A Pictorial Essay

Traumatic lesions of the wrist occur frequently and may give rise to underdiagnosed secondary abutment syndromes. The latter are a common cause of incapacitating pain and limited range of motion, despite minimal or even absent alterations on radiographs. Moreover, the complex wrist anatomy often results in ignorance or underappreciation of these syndromes. This paper presents a pictorial review of frequent and rare secondary abutment syndromes at the wrist joint, which – in contrast to primary abutment syndromes – are not based on anatomical variants or congenital deformations. The merit of each imaging modality is briefly mentioned.

Imaging Findings at the Quadrangular Joint in Carpal Boss

A carpal boss was initially described as a bony, sometimes painful mass at the quadrangular joint. Clinical examination and plain radiography will usually reveal the diagnosis. US and CT may add information. MRI may illustrate a variable bony morphology and additional bony and soft tissue pathologies. Bone marrow edema shows a significant correlation with a painful carpal boss. Hence, MRI may be of additional diagnostic value in patients with persistent pain and preoperatively. This paper presents a review of the anatomy and pathology in carpal boss. The merit of each imaging modality – in particular MRI – is mentioned.

Familial Multiple Cavernous Malformation Syndrome: MR Features in This Uncommon but Silent Threat

Cerebral cavernous malformations (CCM) are vascular malformations in the brain and spinal cord. The familial form of cerebral cavernous malformation (FCCM) is uncommon. This autosomal dominant pathology mostly presents with seizures and focal neurological symptoms. Many persons affected by FCCM remain asymptomatic. However, acute hemorrhages may appear over time. MRI demonstrates multiple focal regions of susceptibility induced signal loss, well seen on gradient-echo sequences (GRE) or even better on susceptibility-weighted imaging (SWI). The presence of a single CCM – especially in young persons – without history of FCCM does not exclude this diagnosis. Some clinicians also advise an MRI of the spinal cord at the time of diagnosis to serve as a baseline and a control MRI of the brain every one to two years. MRI is certainly indicated in individuals with obvious new neurologic symptoms. Symptomatic siblings should also undergo an MRI of the brain to determine presence, size, and location of the lesions. Even in asymptomatic siblings, a screening MRI may be considered, as there may be an increased risk of hemorrhage, spontaneous or due to the use of certain medications; the knowledge of the presence and the type of these lesions are important. Surgical removal of a CCM may be justified to prevent a life-threatening hemorrhage. Control MRI may reveal the postoperative outcome.

Correction: Imaging Findings of the Distal Radio-Ulnar Joint in Trauma

This article details a correction to: Mespreuve, M, Vanhoenacker, F and Verstraete, K 2015 Imaging Findings of the Distal Radio-Ulnar Joint in Trauma. Journal of the Belgian Society of Radiology, 99(1), pp. 1–20, DOI: http://dx.doi.org/10.5334/jbr-btr.846