MRI of the wrist joint

The wrist joint has many features: despite its small size, this articulation is subjected to constant and significant loads. If the wrist begins to bother and the patient turns to the doctor, then only an analysis of the clinical symptoms will not be enough. It is necessary to connect additional instrumental diagnostics - in particular, the doctor can prescribe MRI of the wrist joint. Often, only on the basis of MRI results, a doctor can identify the disease.

[1], [2], [3]

Indications for the procedure

The medicine knows a lot of diseases and damages that can disrupt the functional ability of the wrist and hand. In order to correctly diagnose and prescribe further treatment, differential diagnosis is performed - including, using a procedure such as magnetic resonance imaging.

MRI of the wrist joint is indicated for such possible diseases:

• Anomalies of development.

Often anomalies in the development of articular elements are detected by chance - especially if such defects do not cause serious functional limitations. Physicians sometimes manage to diagnose the concreteness (connection) of small bone elements with each other, which to a certain extent reduces the motor amplitude in the radiocarpal joint.

In addition, it is possible to detect hypoplasia or aplasia of individual bones or parts thereof. With a similar anomaly, on the contrary, pathological mobility arises in the joint. More rarely, additional elements are found in the wrist.

To the violation of the functionality of the wrist also lead such congenital pathologies as dislocation and subluxation of the wrist joint. Fortunately, these defects are not so common, and they are treated in an operative way.

• Injuries.

Most often traumatologists have to diagnose bruises, internal hematomas or hemarthrosis in the wrist joint. Dislocation of articulation is rare, as in most cases they are found against the background of a fracture of the radius or styloid process.

In a series of injuries, the bones inside the joint are most often determined by a fracture of the distal epiphysis of the radius, or its fracture in a characteristic place (the so-called Collis fracture). Often, such damage occurs against the background of damage to the head of the ulna, the styloid process and the joint disc.

• Inflammation of the joints.

Arthritis of the wrist joint can be acute or chronic, infectious or post-traumatic. In the series of chronic arthritis, the use of MRI is often required such diseases as rheumatoid and reactive arthritis, joint damage in patients with tuberculosis or brucellosis.

• Osteoarthritis.

After various injuries or joint inflammation, arthrosis with deformity of the wrist joint can develop. This pathology is rare, but it is extremely important to diagnose it in a timely manner. With prolonged current deforming arthrosis, there is a gradual increase in stiffness, deformation, and patients complain of frequent crunches and pain during movements.

• Kinbeck's disease.

Osteonecrosis of the semilunar bone is also called carpal osteochondritis or osteochondropathy, lunatomalacia, avascular necrosis, or aseptic necrosis of the wrist. The essence of the disease lies in the limited movements in the wrist joint (some patients can not even squeeze their fingers into a fist). This pathology is not considered rare.

• Diseases of soft tissues of the wrist joint.

Such diseases affect the soft tissues of the joint, and for their diagnosis, an MRI procedure is often prescribed:

• inflammation of the joint bag;
• tenosynovitis and tendonitis;
• periarthrosis;
• ligament.

It should be remembered that tumor processes can also form in the wrist zone - for example, it may be about chondroma, osteosarcoma, osteoma, etc. Therefore, for any such suspicions, the doctor can prescribe to the patient this type of diagnosis, such as MRI of the wrist joint.

[4], [5], [6]

Preparation

In the vast majority of cases, the MRI of the wrist joint does not require any special preparation: the articulation is perfectly visualized. If contrasting is used, the doctor may warn about the need for fasting. It is advisable to consult a doctor beforehand to determine whether there are any contraindications to the procedure: during the consultation, the medical specialist will explain to the patient all aspects of the study.

First of all, the doctor should pay attention to the following questions:

• whether the patient has contraindications to this type of diagnosis (such contraindications may be different, depending on what type of MRI device is used - closed or open);
• Whether application of contrast before procedure is necessary - and if yes, whether the patient has an allergy on a contrast substance;
• Whether there is a necessity for additional reception of restful or analgesic preparations before procedure.

It is worth noting that MRI of the wrist joint is considered a relatively common type of diagnosis, and it is often performed on open-type devices. The open procedure significantly simplifies the preparation and reduces the likelihood of stress in the patient. The type of the device is not affected by the accuracy and informativeness of the results.

[7],

Technique MRI of the wrist joint

To ensure that during the MRI procedure of the wrist joint the patient does not encounter any surprises, he should at least in general outline how the study is conducted. So, the standard technique of carrying out the procedure is as follows:

• The patient takes off his outer clothing, as well as all foreign objects (jewelry, watches, hearing amplifiers, etc.);
• placed horizontally on a special pull-out couch, which then pushes into the apparatus (with the open procedure, the patient simply assumes a sitting position and places the test arm inside the apparatus);
• for the necessary time (approximately 20 minutes), the patient must observe complete immobility.

After the end of the procedure, the patient should stay in the office for a while, in order for the doctor to make sure that everything went well and there is no need for additional manipulations.

If sedation or anesthesia was additionally applied before the MRI, then after the procedure, one of the relatives should accompany the patient - home or in a hospital. Self-management of transport after sedation to the patient is prohibited.

What is the MRI of the wrist joint?

The qualitative image of the wrist joint in MRI images is obtained only in the most uniform magnetic field, which can not be achieved without using additional alignment. Therefore, in the MRI apparatus, special shimming coils are added to the base magnet, creating gradients that compensate for the technical magnetic inhomogeneity and neutralize the effect on the field of the patient himself. Coils create gradient pulses in three spatial directions and are coordinated by a system of amplifiers.

The radio impulse sensor (also called the transfer coil of the MRI device) delivers waves with a resonant frequency, modulating them into pulses of a certain type.

The receiving coil is a sensitive antenna placed against the direction of the base magnetic field. To avoid interference, the MRI magnet is placed in a special chamber (the so-called "stand") made of copper or aluminum sheets or rods. The received signal is converted into a digital form by an analog-digital transformer, and then it is broadcast to the computer. The image is reconstructed and a tomogram is displayed on the monitor.

The described principle of operation of the device MRI helps to give an accurate assessment of the state of soft tissues, cartilage, ligamentous apparatus. To a lesser extent it is informative to carry out MRI of the wrist joint in case of bone tissue damage.

What gives MRI of the wrist and wrist joint?

1. During the research, it becomes possible to obtain a detailed picture of the problem area. Therefore, MRI of the wrist joint is especially effective for early diagnosis of tumor and inflammatory processes.
2. MRI helps to examine those areas that are not visualized by CT - for example, by overlapping the required area with bone tissue, or because of the poor sensitivity of CT to the altered tissue density.
3. MRI allows you to evaluate not only the structure of tissues, but also the quality of their functioning (for example, you can fix the speed of blood flow).

The results obtained during the MRI of the wrist joint are given to the patient's hands or passed on to the doctor. This can happen in a couple of hours, or the next day after the procedure.

Contraindications to the procedure

Limitations to the MRI of the wrist joint are absolute and relative (that is, temporary). Absolute restrictions are:

• presence in the body of a foreign object made of metal;
• presence of a metal or electromagnetic implant or prosthesis;
• the presence of a pacemaker, an insulin pump.

If a wrist joint with contrast is required, this procedure can not be performed in patients with renal insufficiency or hypersensitivity to the contrast agent ingredients.

Relative restrictions can be:

• pregnancy during the first trimester;
• mental disorders, panic attacks, schizophrenia, phobia of enclosed space (when using a closed device);
• heavy decompensated states;
• presence of tattoos with metal-containing dyes;
• severe pain, itching - that is, symptoms that interfere with the patient's prolonged immovable position;
• the state of alcohol or drug intoxication.

For devices of closed type, obesity is also considered a contraindication, since the MRI camera has limitations on the weight and volume of the patient's body. It is believed that for the procedure, the maximum weight of the patient should not exceed 150 kg. Apparatuses of open type do not have such a limitation.

Children's age can not be a contraindication, as such. However, it is sometimes difficult to diagnose children, first of all, because children simply can not stay immobile for a long time. If there is an urgent need for MRI of the wrist joint to the child, it is possible to pre-use sedatives or anesthesia.

[8], [9], [10]

Complications after the procedure

MRI of the wrist joint - with contrasting, or in the usual way, this is an important diagnostic study, and it is very important for the patient to understand exactly how it affects the body. It should be noted that to date, no proven fact of the harmful effects of the procedure on health is known. Most experts agree that MRI does not affect the performance of the organism in any way, either way.

Some people without proper experience can argue that MRI (including wrist joint) is capable of harming health due to prolonged exposure to a powerful magnetic field. In fact, this is not so: the magnet interacts only with hydrogen atoms, and with no more. It turns out that the water molecules present in the body are simply aligned in parallel with the magnetic field, which in no way can affect the state and functions of the body.

You can give an explanation and the principle of image formation. Under the influence of a magnetic wave, previously built atoms begin to oscillate, radiating energy, which in the future and is converted into an image. Thus, both the magnetic field and the radiation are completely safe. Experts are sure that the procedure for MRI of the wrist joint can be repeated several times if necessary: it does not affect the health of the body in any way.

Does the type of MRI device used for patient safety matter? Can there be complications of health after an open or closed procedure?

The closed device looks like a special cylindrical chamber, open on both sides. The patient "enters" this cell, lying on a mobile couch, and there is a certain time. If a person suffers from attacks of claustrophobia, then do not try fate: it is better to abandon the closed procedure in favor of an apparatus of an open type. Otherwise, there may indeed be some problems of a corresponding nature.

Both open and closed apparatus can cause complications if the patient does not warn the doctor about the presence of metal implants in his body, about the presence of an allergy to a contrast agent, and about other possible contraindications to the study.

• If the patient does not warn the doctor about the presence of a serious kidney disease, then under the influence of the magnetic field and the contrast agent, the pathology can be transformed into nephrogenic fibrosis.
• If the patient does not get rid of the metal objects on the body before the procedure, then some skin problems may occur in the form of superficial tissue damage.
• If the patient has a device by the type of a pacemaker, then it can simply stop working during the procedure: it is easy to predict the outcome of such a situation.
• If the patient has an allergic predisposition to the components of the contrast medium, then after the introduction of the latter can be observed:
  • difficulty breathing;
  • increased heart rate;
  • skin rash, swelling, etc.

It is very desirable to make a test for lack of allergy before the contrasting. This will prevent very unpleasant consequences and complications.

[11], [12]

Care after the procedure

Virtually all patients after the MRI of the wrist joint can independently go home: special treatment and care is not required for them. The doctor can ask the patient to wait about an hour in the next room, for the delivery of pictures and medical advice. In some cases, the results are transmitted directly to the treating physician.

In some clinics, it is common practice to record MRI data on a USB storage medium. In such a case, the patient expects less time.

If a patient is given sedatives before an MRI or anesthesia is given, then a close person should accompany him after the procedure. Self-movement of the patient after sedation or anesthesia - on foot or in transport - is prohibited. If you feel worse, you should immediately contact your doctor.

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Reviews

MRI examination is considered to be one of the most modern, accurate and safe diagnostic procedures. Such diagnostics is informative, painless and can be used even in pediatrics. The field of proven safety of MRI is the preferred method of investigation, unlike radiography or computed tomography. Moreover, the X-ray does not have this accuracy: this method is more suitable for diagnosing injuries of the bone system. Computer tomography is more informative, but also implies the use of X-ray irradiation. Therefore, in this aspect, the use of magnetic resonance imaging is preferable.

Relatively high cost is, perhaps, the only explicit "minus" MRI of the wrist joint. However, most patients still choose this type of diagnosis because of its informative and safety.