الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The wrist joint is considered to be the most complex articulation in the human body. The small size of the anatomic structures, the diversity of disorders that can cause symptoms, and the high rate of asymptomatic findings are some of the factors that contribute to the difficulty of diagnosis and management in this region.
Magnetic resonance image (MRI) has become the preferred modality for imaging patients with internal derangement of the wrist, which include lesions of the triangular fibrocartilage complex (TFCC), scapholunate and lunotriquetral ligaments.
The triangular fibrocartilage complex consists of the triangular fibrocartilage proper (articular disk), the dorsal and palmar radioulnar ligaments, the ulnocarpal meniscal homologue, the dorsal and palmar ulnocarpal ligaments, the sheath of the extensor carpi ulnaris tendon, and the capsule of the DRUJ.
Injury to this ligamentous complex is responsible for many cases of ulnar wrist pain, once considered the “low back pain of the wrist”.
Wrist pain is a common clinical complaint attributed to many causes including traumatic & non traumatic abnormalities involving avascular necrosis, ganglia ,TFC lesions, ligaments lesions, DRUJ lesions, arthritis ,fractures, neoplasms ,tendinopathy and neuropathy lesions.
This study included 50 patients presented with wrist pain. Patients included in this study were subjected to the following: Careful history taking, full clinical examination, plain radiographic
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examination of the wrist for all patients and magnetic resonance imaging of the wrist.
Results of plain radiographs had been normal or inconclusive in most of wrist pathological lesions in comparison of other modalities. The plain radiography may detect the earliest sign of rheumatoid arthritis (RA) in the form of periarticular soft tissue swelling with a fusiform appearance, and detects the late signs in the form of narrowing joint space, bony erosion and joint deformities and also may helps in diagnosis of carpal fractures.
MRI provides unique anatomic information makes it an effective modality to determine the cause of the common pathologic lesions of the wrist for example: avascular necrosis, ganglion cysts, triangular fibrocartilage complex tears, ligamentous tears, DRUJ subluxation, rheumatoid arthritis, fractures, soft tissue masses, tenosynovitis and carpal tunnel syndrome.
MRI is superior in diagnosis of avascular necrosis (AVN), in the early stage ischemia results in a bone marrow edema, reducing the marrow signal in T1-weighted, increasing it in T2-weighted sequences. After complete marrow necrosis there is an intense loss of signal intensity Tl- and T2-weighted images. MRI is superior in diagnosis of ganglia. Another advantage of MRI over other modalities in trauma is the detection of soft tissue injuries as TFCC and ligaments tear. The TFCC tear seen as discontinuity with abnormal focal area of increased signal intensity at both T1 and T2 weighted images. Also it is effective in diagnosis of DRUJ subluxation .Also in acute fractures, edema or hemorrhage appears as a low or intermediate signal on T1 weighted image (WI) around the fracture site. The area of edema shows increased signal on T2 WI. Linear low signal
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intensity band that remain low signal on both T1and T2-weighted sequences are consistent with fracture line.
MRI is superior also in diagnosis of inflammatory changes related to RA as; synovial thickening and hypertrophy, and pannus formation before the onset of bony erosion, detect early subcortical cystic changes. Lipomas in MRI they are of high signal onT1 weighted images and should be of homogeneous low signal on fat suppressed and STIR images. In carpal tunnel syndrome MRI shows diffuse swelling or segmental enlargement of the median nerve may be demonstrated in the form of the increased T2-weighted signal within the median nerve consistent with early or mild inflammation, Alterations in the median nerve signal intensity may represent edema or demyelination within neural fibers.
from this study we concluded that MRI has a dramatic impact on the diagnosis and assessment of variety of wrist disorders .It is non invasive and ideal modality to demonstrate the complex anatomy and pathological conditions of the wrist.