Wrist arthrography today.

In recent years, wrist arthrography has been criticized for having low sensitivity and low specificity. This largely has been due to widely varying and less than rigorous technique and the reliance on criteria for abnormality that are now known to be invalid. Other criticisms have included the length of time needed to perform a three-compartment arthrogram with or without comparison to the contralateral side and the radiation dose to the patient. It is our belief, however, that with the use of the patient's history, symptoms and physical examination to develop a focused examination strategy, and with the use of digital equipment, the examination can be performed quickly and with minimal radiation dose to the patient. In order to improve the accuracy of arthrography, the radiologist must abandon the concept that simply identifying a communicating defect between the carpal compartments is a criterion for abnormality. He or she must utilize a meticulous approach to determine the site of communication to evaluate the features of the defects in order to determine the significance of the defect. As more is learned about the nature of traumatic and attritional defects and with further technologic advancements in cross-sectional imaging and three-dimensional rendering, it is quite possible that arthrographic imaging of the wrist will experience a resurgence of interest in the evaluation of posttraumatic wrist pain, avoiding the fate of such examinations as pneumoencephalography and oral cholecystography as many have predicted.