Dynamic Rotation MRI of the Wrist: Detecting Subluxation/ Luxation of the Extensor Carpi Ulnaris Tendon

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1 Dynamic Rotation MRI of the Wrist: Detecting Subluxation/ Luxation of the Extensor Carpi Ulnaris Tendon Poster No.: P-0039 Congress: ESSR 2014 Type: Scientific Poster Authors: B. Henninger, F. Kellermann, R. Arora, M. Gabl, M. Lutz, C. Kremser, A. Rudisch; Innsbruck/AT Keywords: DOI: Trauma, Image verification, Imaging sequences, Diagnostic procedure, MR-Functional imaging, MR, Musculoskeletal system, Musculoskeletal soft tissue /essr2014/P-0039 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Purpose The extensor carpi ulnaris tendon (ECU) is stabilized by a fibro-osseous tunnel, formed by the distal ulna and a band of connective tissue referred as the ECU subsheath. Subluxation or luxation of the ECU can occur at this location related to an injury to the ECU subsheath. The purpose of this study was to evaluate the dynamic rotation MRI (DR-MRI) of the wrist for the assessment of subluxation/luxation of ECU. Methods and Materials 24 patients (5 male, 19 female, mean age 35, years) with clinical signs of ECU pathology (pain dorsally at the distal ulna and crepitus) and suspicion of subluxation/ luxation were retrospectively enrolled. All patients had a consecutive DR-MRI (1.5T, Avanto, Siemens, Erlangen, Germany) of the wrist using an extremity-coil and a custom positioning device with the following protocol: axial true-fisp acquired separately during active pronation and supination movement (SL 6mm, TE 1.55ms, TR 543.2ms, flipangle 40, FOV 208x190mm, voxel-size 0.74x0.74x6mm³). Total facility time per patient was about 15 minutes. Every patient had surgical treatment within a maximum of 3 months after MRI. Results of the DR-MRI were correlated with surgical findings. Thereby intraoperative findings of subluxation/luxation of the ECU were determined as the goldstandard. Results DR-MRI was feasible in all examined patients. In 24/24 patients MRI revealed subluxation/luxation of the ECU tendon during movement. Correlation with surgical findings revealed a rupture of the ECU subsheath with luxation/subluxation in 24/24 patients. Fixation of the ECU with an extensor retinaculum sling was performed in all patients. Images for this section: Page 2 of 9

3 Fig. 1: Dynamic rotation MRI (DR-MRI) of the right wrist in supination movement. Patient had pain dorsally at the distal aspect of the ulna. The extensor carpi ulnaris tendon (ECU) is shown regular in the sulcus at neutral position (first image, white arrow). With DR-MRI subluxation at the styloid processus (images in third row, white arrow) is proven during movement and can be interpreted using a cine display. Fig. 2: DR-MRI showing a luxation of the ECU from pronation to supination in a 26year old woman. Page 3 of 9

4 Fig. 3: This example shows a total luxation of the ECU tendon in a 43year old man. Page 4 of 9

5 Conclusion DR-MRI is a feasible, fast and accurate method for the detection of subluxation/luxation of the ECU. References Cift H, Ozkan K, Söylemez S, Ozkan FU, Cift HB. Ulnar-sided pain due to extensor carpi ulnaris tendon subluxation: a case report. J Med Case Rep Jan;6(1):394. Wijffels M, Brink P, Schipper I. Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J Jan;6: Spinner M, Kaplan EB. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res. 1970;68: Taleisnik J, Gelberman RH, Miller BW, Szabo RM. The extensor retinaculum of the wrist. J Hand Surg Am Jul;9(4): Campbell D, Campbell R, O'Connor P, Hawkes R. Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. Br J Sports Med Nov;47(17): Boutin RD, Buonocore MH, Immerman I, Ashwell Z, Sonico GJ, Szabo RM, et al. Realtime magnetic resonance imaging (MRI) during active wrist motion--initial observations. PLoS One Jan;8(12):e Personal Information Dr. Benjamin Henninger is working at the Medical University of Innsbruck, Department of Radiology. He is the organization manager of the MRI section and responsible for the general body MR imaging. He is specialized in Body-MRI with a clinical and scientific focus on liver imaging and musculoskeletal imaging. Page 5 of 9

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8 Fig. 4: Dr. med. univ. Benjamin Henninger Page 8 of 9

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