Purpose
The purpose of this study was to determine the accuracy of the wrist insufflation
test based on mean radiocarpal and midcarpal joint space volumes.
Methods
Twenty-nine patients underwent 3-4 portal radiocarpal and radial midcarpal portal
insufflation before wrist arthroscopy. The volume remaining in the radiocarpal space
at equilibrium was recorded, and the contour of the dorsal wrist and distal radioulnar
joint was palpated for a fluid wave. After insufflation, wrist arthroscopy was performed
and diagnoses were recorded. The mean volumes of the intact radiocarpal and midcarpal
spaces were then compared with those of the compromised radiocarpal and midcarpal
spaces to determine the overall sensitivity and specificity of the test.
Results
A total of 29 patients (18 male and 11 female) underwent wrist insufflation before
wrist arthroscopy. The mean age of the patients was 42 years (range, 17 to 69 years).
Intact radiocarpal spaces accepted a mean of 3.5 ± 0.16 mL of fluid, whereas compromised
radiocarpal spaces accepted a mean of 5.5 ± 0.48 mL of fluid (P < .01; 95% confidence interval, 2.87 to 3.30). Intact midcarpal spaces accepted a
mean of 2.5 ± 0.18 mL, whereas compromised midcarpal spaces accepted a mean of 5.6
± 0.38 mL (P < .01; 95% confidence interval, 1.70 to 2.30). The overall sensitivity of the test
was 83.3%, and the overall specificity was 100%.
Conclusions
Complete scapholunate interosseous ligament and triangular fibrocartilage complex
tears can be detected when there is an increased radiocarpal joint space volume with
insufflation through the 3-4 portal combined with a fluid wave over the radial midcarpal
space or the distal radioulnar joint. Complete scapholunate interosseous ligament
and lunotriquetral interosseous ligament tears can also be detected when there is
an increased midcarpal space volume with insufflation through the radial midcarpal
portal combined with a fluid wave over the radial radiocarpal space or the ulnar radiocarpal
space.
Level of Evidence
Level IV, therapeutic case series.
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Article Info
Publication History
Accepted:
December 31,
2013
Received:
July 7,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: J.Y. receives support from Arthrex, Smith & Nephew Endoscopy, TriMed.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
