OBJECTIVETo measure the synovial thickness in the bilateral wrist joints, metacarpophalangeal (MCP) joints and proximal interphalangeal (PIP) joints using high-resolution intraoperative ultrasound probe in healthy young and middle-aged volunteers to determine the normal reference ranges of synovial thickness in the joints.

METHODSThis study was conducted in 100 healthy young and middle-aged volunteers, including 50 male (mean age 36.2∓5.0 years; range 18-54 years) and 50 female (mean age 38.8∓5.5 years; range 20-56 years) individuals. The synovial thickness in the bilateral wrist joints, MCP joints and PIP joints was measured using the GE Logiq S8 18 MHz polo stick-like linear probe array.

RESULTSs No statistical significance was found in the synovial thickness of the wrist joints, MCP joints and PIP joints between the left and right hands, between young (<40 years) and middle-aged (≥40 years) subjects, or between the flexor surface and the extensor surface. In the male subjects, however, the synovial thickness in the wrist joints, MCP joints and PIP joints was significantly greater than that in female subjects. A significant difference was noted in the synovial thickness between the wrist joints, MCP joints and PIP joints.

CONCLUSIONMeasurement of the synovial thickness of the wrist joints, MCP joints and PIP joints using high-resolution intraoperative ultrasound probe is beneficial for early diagnosis and therapy of rheumatoid arthritis.

Adolescent ; Adult ; Arthritis, Rheumatoid ; diagnostic imaging ; Female ; Hand ; diagnostic imaging ; Humans ; Male ; Metacarpophalangeal Joint ; diagnostic imaging ; Middle Aged ; Synovial Membrane ; diagnostic imaging ; pathology ; Ultrasonography ; Wrist ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman's vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.
Adult ; Female ; Ganglion Cysts ; diagnostic imaging ; pathology ; surgery ; Humans ; Lunate Bone ; diagnostic imaging ; pathology ; surgery ; Wrist ; diagnostic imaging

OBJECTIVETo explore a new method in estimating extent and degree of arterial injury in upper limbs sustaining high tension electric burns.

METHODSEighteen patients (twenty-four upper limbs) with high tension electricity injury were admitted from December 1998 to September 2002, The damaged limbs consisted of four parts: wrist wound part, 5 cm, 10 cm, 15 cm parts around wrist wound, where the radial and ulnar arteries were detected using B ultrasound and color WP Doppler examination. The changes of endangium, vessel diameter, thickness of the vessel wall and volume of blood flow were recorded respectively. The parameters of normal radial and ulnar arteries were also determined as normal control.

RESULTSB ultrasound and color WP Doppler examination showed that the endangium in radial and ulnar arteries become coarse, edema or exfoliation. The vessel wall was thicker than that of the normal control and the thickness was heterogeneity. The vessel wall could be necrosis in severe patient and the vessel cavity was stricture or beaded. Thrombosis or occlusion could occur at the site of severe injury area in vessel. The decrease in volume of blood flow was observed. The condition of the radial and ulnar arteries become well apart from 10 - 15 cm of wrist wound.

CONCLUSIONSThe ultrasonography can be used to detect the changes in endangium, diameter, thickness of the vessel wall, blood flow volume in injury blood vessel caused by electric burn injury. It is helpful in judging the degree and extent of injury vessel and could be a safe, non-invasive diagnostic method and is worth popularizing.

Adolescent ; Adult ; Burns, Electric ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging ; injuries ; Ulnar Artery ; diagnostic imaging ; injuries ; Ultrasonography ; Wrist Injuries ; diagnostic imaging

OBJECTIVE: To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents. METHODS: One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method. RESULTS: Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%. CONCLUSION Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.
Adolescent ; Age Determination by Skeleton/methods* ; Epiphyses/diagnostic imaging* ; Female ; Forensic Anthropology/methods* ; Hand Bones/diagnostic imaging* ; Humans ; Radius/diagnostic imaging* ; Reference Standards ; Wrist/diagnostic imaging*

OBJECTIVETo explore distinctive manifestations of rheumatoid arthritis (RA) patients of cold syndrome and heat syndrome using wrist joints ultrasound.

METHODs Totally 65 RA patients were syndrome typed as cold syndrome (29 cases, cold-damp blockage syndrome) and heat syndrome (36 cases, damp-heat obstruction syndrome). Grey-scale synovitis, power doppler (PD) signals, tenosynovitis, and bone erosion were observed using wrist ultrasound. Distinctive manifestations of cold syndrome and heat syndrome were analyzed using wrist ultrasound.

RESULTSIn RA patients of cold syndrome, the positive rate of synovitis, PD, tenosynovitis, and bone erosion was 51.72%, 20.68%, 51.72%, and 37.93%, respectively, while they were 97.22%, 91.67%, 75.0%, and 63.89%, respectively in RA patients of heat syndrome. Compared with patients of cold syndrome, the positive rate of synovitis, PD, and bone erosion increased in patients of heat syndrome (P < 0.01, P < 0.01, P < 0.05). There was no statistical difference in the positive rate of tenosynovitis between the two groups (P > 0.05). Compared with the cold syndrome group, there was statistical difference in the constituent ratio of synovitis, PD, and bone erosion in the heat syndrome group (P < 0.01, P < 0.01, P < 0.05), but with no statistical difference in the constituent ratio of tenosynovitis (P > 0.05). Results of the ROC curve showed that the sensitivity was 86.1% and the specificity was 62.1% in judging heat syndrome, when the total score of synovitis in two wrists was more than 1.5; the sensitivity was 80.0% and the specificity was 93.1% in judging heat syndrome, when the total score of PD in two wrists was more than 1.5.

CONCLUSIONSPositive rates of synovitis, PD, and bone erosion were significantly higher in RA patients of heat syndrome than those of cold syndrome. Especially serious manifestations were more often seen in RA patients of heat syndrome. The total score of synovitis or PD in the two wrist joints higher than 1.5 was characteristic manifestations of heat syndrome using wrist ultrasound.

Arthritis, Rheumatoid ; therapy ; Hot Temperature ; Humans ; Medicine, Chinese Traditional ; ROC Curve ; Sensitivity and Specificity ; Syndrome ; Synovitis ; Ultrasonography ; Wrist ; diagnostic imaging ; Wrist Joint ; diagnostic imaging

OBJECTIVE: To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation. METHODS: PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 μm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 μm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated. RESULTS: There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other. CONCLUSION The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.
Beijing ; Brachial Artery ; Fluoroscopy ; Fractures, Bone/diagnostic imaging* ; Hamate Bone/injuries* ; Humans ; Ulna ; Wrist Injuries/diagnostic imaging* ; X-Ray Microtomography

OBJECTIVESTo establish a clinical method for measuring the displacement of the distal radioulnar joint (DRUJ) precisely irrespective of ulnar variance, and to derive normal population translation references with palmar and dorsal stress.

METHODSThirty-seven normal distal forearms were scanned with computed tomography using an apparatus designed by Pirela-Cruz. Each extremity was scanned in two positions: maximal ulnar palmar and dorsal stress. The digital imaging and communications in medicine (DICOM) CT images were then imported into Mimics 10.0 for three-dimensional reconstruction. On the DRUJs 3D images, choose the most prominent point of the palmar and dorsal margins of the sigmoid notch and the excavate ulna fovea as the reference points A, B and C. A perpendicular line was then drawn from the point C to a line connecting points A and B with the intersection D. Calculate the ratio of AD/AB and DB/AB. Two observers measured all the DRUJs independently and one repeated the measurements one month later to determine the interobserver and intraobserver reliability.

RESULTSThe mean ratio values of palmar (AD/AB) and dorsal (DB/AB) translation were 0.39 ± 0.07 and 0.37 ± 0.07, and the normal references (x(-) ± 2 s) were from 0.25 to 0.50 and from 0.23 to 0.50, respectively. No significant differences were observed in terms of positions, genders and dominant hands. The intraclass correlation coefficient (ICC) values for interobserver and intraobserver reliability (DB/AB, AD/AB) were 0.84, 0.80, 0.93 and 0.92, respectively.

CONCLUSIONSThis new method could accurately measure the displacement of DRUJs with acceptable reliability, even with ulna positive or negative variance. Instability of DRUJ may be indicated when AD/AB is less than 0.25 or BD/AB is less than 0.23.

Adult ; Aged ; Female ; Humans ; Imaging, Three-Dimensional ; Joint Dislocations ; diagnostic imaging ; Joint Instability ; diagnostic imaging ; Male ; Middle Aged ; Radius ; diagnostic imaging ; Tomography, X-Ray Computed ; Ulna ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain's disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.
Adult ; Fractures, Bone ; diagnostic imaging ; Golf ; injuries ; Hamate Bone ; diagnostic imaging ; injuries ; Humans ; Male ; Tendinopathy ; Tomography, X-Ray Computed ; methods ; Wrist Injuries ; diagnostic imaging

OBJECTIVETo provide the basic knowledge of wrist joint for diagnosing of these morphological change in pathological condition by measuring the posteroanterior X-ray films of different types of distal radius fracture by AO classification.

METHODSEleven radiographic indexes were measured including following 7 new parameters of 83 cases of distal radius fracture: ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width (PDRW), sigmoid notch length (SNL) and sigmoid notch width (SNW) by Pacs system in standard X-ray films. The indexes were defined by the ratio of these parameters to the length of the third metacarpal. Statistical significance of indexes and correlations of parameters were analyzed by SPSS 16.0.

RESULTSIt was found that indexes of 11 parameters and 27 pairs of indexes had significantly different. Compared the indexes of 14 groups with normal group existed statistical significance, 62 pairs value of 11 parameters had correlations.

CONCLUSIONThe study provides additional radiographic index that will be helpful to more careful diagnosis and treatment of the distal radius fractures and their associated injuries such as ulnar wrist injuries or carpal instability.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Radius ; diagnostic imaging ; Radius Fractures ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

OBJECTIVE: To research the connection of the minor's bone age and chronological age and age for penal responsibility, to discuss the application of Gu's Atlas and Li Guozhen's Percent Numeration to measure the bone age in the cases of immature criminals and the applying value. METHODS: 33 healthy youths, 12-19 years old, were selected, whose left wrists were photographed with X-rays. According to the radiographic appearance of the maturity indicators, the bone age of every person was determined respectively by the Gu's Atlas and Li Guozhen's Percent Numeration, and then compared with his/her chronological age. CMH test and Pearson test were used to evaluate precision and accuracy on concluding the immature age for penal responsibility. RESULTS: Li Guozhen's Percent Numeration was more precise than Gu's Atlas on extrapolating the chronological age of the youth, P<0.005. On extrapolating the age for penal responsibility, the accuracy of the former was 90.91%, and the latter was 78.79%, but the statistic result did not show significant difference (P>0.1). CONCLUSION Both measurements can apply in determining the criminal cases of immature youths.
Adolescent ; Adult ; Age Determination by Skeleton/methods* ; Child ; Female ; Forensic Anthropology/methods* ; Hand/diagnostic imaging* ; Humans ; Male ; Metacarpal Bones/diagnostic imaging* ; Wrist/diagnostic imaging*