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The Wrist Insufflation Test: A Confirmatory Test for Detecting Intercarpal Ligament and Triangular Fibrocartilage Complex Tears

  • Daniel Lee Master
    Correspondence
    Address correspondence to Daniel Lee Master, M.D., Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St, Redwood City, CA 94063, U.S.A.
    Affiliations
    Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, U.S.A
    Search for articles by this author
  • Jeffrey Yao
    Affiliations
    Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, U.S.A
    Search for articles by this author

      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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