Wrestling with Wrist Pain: What is a "Normal" Arthrogram Worth?Arthrography is one way doctors diagnose wrist pain. By injecting the wrist with a special substance, doctors can see problems in the wrist that may be causing symptoms. Recently, this method has been put under the microscope. Some think arthrography finds problems where there are none, or locates problems in the wrong places. Others have noted that arthrography misses problems that are then identified by arthroscopy, a technique that uses a small TV camera to see under the skin. Can arthrogram results be trusted? If your wrist arthrogram comes out "normal," what does it mean?
These doctors wanted to see how people with normal wrist arthrograms were doing at least two years later. They surveyed 42 patients who had inconclusive physical exams, and normal arthrogram and X-ray results. The patients averaged 26 years old. They had experienced symptoms for about a year. Most of them had a specific wrist injury. Others had clicking or grinding in the wrist. The kind of arthrogram used was single injection. (Triple injection has come into use more recently, with more accurate results.)
After getting normal arthrography results, patients were treated with splints, anti-inflammatory medication, and activity modification. They did not have surgery.
Patients were followed up about six years after arthrography. Compared to people with no history of wrist symptoms, the patients in this study had more problems doing daily activities. These activities included opening a tight jar, doing heavy household chores, carrying objects over 10 pounds, and doing recreational activities that involved the hand or arm. Mild pain, stiffness, and weakness of the wrist were also common. However, these problems were fairly low overall. Nearly half of the patients had no real day-to-day problems because of their wrists. Also, wrist problems didn't affect patients' physical or mental well-being.
Most patients (64 percent) said their wrists had improved. Nineteen percent said their wrists were the same. Seventeen percent were worse. The longer patients had symptoms before arthrography, the more likely they were to have poor outcomes. Having a workers' compensation claim at the time of arthrography didn't affect patients' outcomes.
Most patients with wrist pain who have inconclusive physical exams, normal X-rays, and normal arthrograms do well without surgery. A small percentage of patients continue to have problems. Whether these problems would be better served by another diagnostic procedure or treatment is unknown. For now, arthrography seems to be a useful tool in diagnosing wrist pain.
Jay C. Jansen, MD, and Brian D. Adams, MD. Long-term Outcome of Nonsurgically Treated Patients With Wrist Pain and a Normal Arthrogram. In The Journal of Hand Surgery. January 2002. Vol. 27A. No. 1. Pp. 26-30.
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