Correlation between Clinical Tests and Magnetic Resonance Imaging Finding in Diagnosis of Chronic Ulnar-sided Wrist Pain

Background: Ulnar-sided wrist pain is a common cause of upper- extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Carful clinical examination should be done, there are some provocative tests for some pathologies which induce pain when the patient has the specific pathology for the test. MRI of the wrist is often challenging because the components of the wrist have complex anatomy of bone and soft tissues, with ligaments and cartilage which are small sized structures measuring millimeters. MRI is a one of advanced imaging techniques that play an important role in evaluating the wrist and is a useful examination modality because of its multiplanar, multisequence capability and its excellent resolution of soft tissue structures. MRI is particularly advantageous for assessing occult bone lesions and soft tissue structures around the wrist such as cartilages, tendons, ligaments and nerves.

Aim: The aim of this study is to assess the role and accuracy of clinical tests and MRI in diagnosis of chronic ulnar-sided wrist pain causes.

Patients and Methods: This is a prospective study and was conducted on a 50 adult patients complaining from chronic ulnar side wrist pain. They were attended to Orthopedic Department of Tanta University Hospitals over a period of 6 months starting from November 2019 till May 2020.

Results: MRI gave positive finding in most of patients (92%), while negative in about (8%) of cases, this means that there are some pathologies need more investigations to be diagnosed. Most of Clinical tests also gave a help in diagnosis of the cause of the pain especially ulnocarpal stress test, fovea sign test, ECU synergy test and piano key test which by statistics showed significant results but LT ballottement test had insignificant results so LTL pathology can't be diagnosed by clinical tests only but needs more investigations as MRI. So some pathologies can be diagnosed clinically as ECU tenosynovitis, but other pathologies need more investigations like MRI like LTL tear, also some pathologies need more investigations.

Conclusion: Most of clinical tests give significant results in diagnosis of chronic ulnar-sided wrist pain except for some pathologies like LTL tear needs more investigations, also MRI has important role and gives significant results in diagnosis.