The anatomic axial plane over the dorsal radius at the level of Lister’s tubercle.Ĭenter the transducer over Lister’s tubercle then visualize the radiocarpal joint by rotating the transducer 90 degrees to the anatomic sagittal plane on the longitudinal axis (see Fig. Transducer orientation: radiocarpal joint Placing the transducer in the anatomic sagittal plane optimizes visualization of most of the wrist joints, with the exception of the DRUJ, which is best visualized in the anatomic axial plane due to its orientation (see Fig. Seated facing the wrist and ultrasound machine monitor. Place the wrist on a rolled-up towel slight wrist flexion opens up the dorsal joint recess. (C) Needle is placed out of plane with transducer from radial to ulnar direction (white arrow 2A.), asterisk denotes location of joint space. Asterisk denotes location of joint space. (B) Needle (arrowheads) placed in plane with transducer from distal to proximal direction (black arrow 2A). White arrow represents path of needle when performing an out of plane injection from ulnar to radial. Black arrow represents the direction of needle when using an in plane approach from a distal to proximal direction. (A) Transducer placed along the anatomic sagittal plane to optimize visualization of the RC and midcarpal joint. Wrist Joint Injections (Radiocarpal, Midcarpal, and Distal Radioulnar Joints)Ī supine or seated position with the forearm fully pronated and wrist in slight flexion ( Fig. Orthobiologics (platelet-rich plasma, bone marrow concentrate, etc.) Local anesthetics for diagnostics, corticosteroids If available, a hockey stick or shorter footprint transducer may also be helpful. Injections can be performed using a high-frequency linear array transducer. Pathologic signs include osteophyte formation, cortical irregularities, articular space narrowing, joint effusions, or thickening of the synovium/synovitis. The anatomic variation of positive ulnar variance may cause abutment of the cartilage and subsequent attritional tearing/degeneration of the TFCC. Prior scaphoid fractures, scapholunate or lunotriquetral ligament (LTL), and TFCC injuries may predispose to post-traumatic arthritis. Injuries to the wrist include dislocations, chronic instability/ligamentous laxity, inflammatory arthritis, and osteoarthritis. The TFCC is composed of fibrocartilage (meniscal homolog), flexor carpi ulnaris tendon sheath, and radioulnar ligaments, which stabilize the DRUJ. The triangular fibrocartilage complex (TFCC) is a construct between the distal ulna and proximal carpal row. The triangular fibrocartilage complex is the fibroligamentous construct between the distal ulna and proximal carpal row. The distal radioulnar joint (yellow) is the articulation between the distal radius and ulna. Mid carpal joint (blue) lies between the proximal and distal carpal row. Note the radiocarpal joint (green) between the radius and ulna proximally and proximal carpal row distally.
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