Wrist instability series: increased yield with clinical-radiologic screening criteria.
OBJECTIVE
To develop screening criteria for patients with wrist pain who have carpal instability.


METHODS
Data were accumulated retrospectively from the cases of 535 patients with painful wrists (321 male and 214 female patients, aged 11-71 years), who underwent wrist arthrography and wrist instability series between 1979 and 1990. Four screening criteria were evaluated: abnormal carpal alignment on routine radiographs, scapholunate joint or ligament pain, reproducible painful clicking or popping, and positive capitolunate instability pattern. Patients with one or more criteria were assigned to group 1. Patients without any of the criteria were assigned to group 2.


RESULTS
Group 1 comprised 142 patients (27%) and group 2 comprised 393 patients (73%). In group 1, 69 (49%) patients had abnormal wrist instability findings, and in group 2, nine (2%) had such findings. All abnormalities in group 2 were depicted on routine arthrograms.


CONCLUSIONS
With use of these screening criteria, the majority of patients with wrist pain do not need to undergo wrist instability series and those that do can undergo a specially tailored series.
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
N P
NP
Truong
F A
FA
Mann
L A
LA
Gilula
S W
SW
Kang
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011859:Radiography; D014954:Wrist Injuries / Q000150:complications; D014955:Wrist Joint / Q000000981:diagnostic imaging