Using arthroscopy as the gold standard, investigators found the accuracy of clinical examination for the diagnosis of common articular wrist conditions was comparable to that of MRI.
There is no significant difference in the diagnostic accuracy of clinical examination or MRI to diagnose wrist pathology, study presenter Sujith Konan, MRCS, of University College London Hospital, said. Clinical examination seems to be consistently more sensitive, but MRIs are more specific.
Konan presented the results the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
Clinical examination vs MRI
For their research, Konan and colleagues studied 66 patients between 10 years to 68 years old who had triangular fibrocartilage complex (TFCC), scapholunate (SL) or lunotriquetral (LT) wrist ligament injuries, and underwent clinical examination and arthroscopy. Of the group, 38 patients also underwent MRI.
Against arthroscopy, clinical examination showed 67.7% sensitivity, 43.8% specificity and 56.1% diagnostic accuracy for any wrist pathology. MRI showed rates of 47.6%, 64.7% and 55.3%, respectively.
For TFCC injuries, clinical examination showed a low sensitivity and high specificity, while MRI showed a higher sensitivity. For LT injuries, MRI showed low sensitivity and high specificity, making them more useful, he said. For SL injuries, MRI showed a low sensitivity and high specificity. However, clinical examination also showed a low specificity for the condition.
Diagnosis of injuries
Konan said that diagnosis of these conditions should be based on a combination of patient history, symptoms, clinical examination and imaging, if necessary. When imaging is necessary, he said the results should be interpreted in the light of the clinical findings. When clinical examination is used, he noted that the level of skill and experience of the clinician is crucial.
To diagnose a TFCC injury in light of a positive examination, Konan said that clinicians should continue to an arthroscopy. If the examination results are equal, clinicians can proceed to arthroscopy or imaging based on the symptoms, he said. When facing SL injuries or uncertain diagnoses, he recommends a combination of clinical examination and imaging. by Renee Blisard
- Ruston J, Konan S, Rubinraut E, Sorene E. Diagnostic accuracy of clinical examination and magnetic resonance imaging for common articular wrist pathology. Paper #400. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb 7-11. San Francisco.
For more information:
- Sujith Konan, MRCS, can be reached at the Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Rd., London NW1 2BU, England; +44 0 20 7679 6248; email: firstname.lastname@example.org.
- Disclosure: Konan has no relevant financial disclosures.