Morphologic and Biomechanical Analysis of the Carpal Ligaments

Study Overview
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Brief Summary
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Compare various dynamic biomechanical markers (distances and angles) in the wrist during dynamic CT studies in three groups of patients: Normal subjects, with scapholunate instability and with other types of wrist instability.

Detailed Description
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Patients referred for the evaluation of wrist pain with CT arthrography will be eligible for inclusion. Patients will benefit from dynamic CT acquisitions before and after arthrography with three maneuvers: radio-ulnar deviation, clenching fist and dart throwing motion. Patients will also benefit from a wrist MR study on a 3 tesla scanner. The morphology of the carpal ligaments will be evaluated on static imaging (MR and CT arthrograph) and on dynamic CT arthrography. Distance and angular measurements will be obtained from dynamic CT studies using an appropriate post processing tool (4D-Ortho). Data obtained with dynamic wrist evaluation will be correlated to ligament morphology, classical wrist instability criteria on conventional radiographs and with surgery (if available).

Official Title
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Morphologic and Biomechanical Analysis of the Carpal Ligaments: a Kinematic Study on Dynamic Area Detector CT

Conditions
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Joint Instability, Wrist Injuries

Intervention / Treatment
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* Device: Dynamic CT
* Procedure: Arthrography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical signs of wrist instability or wrist pain Previous medical examination Informed consent Must have a social security number Exclusion Criteria: MR or CT contra-indications No prior surgery Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Normal subjects<br>No morphologic changes in carpal ligaments or clinical signs of wrist instability. Dynamic CT of the wrist will be performed before and after arthrography. | Device: Dynamic CT<br>* Various low dose CT acquisitions will be successively performed on the wrist to allow a four dimensional evaluation. The same type of acquisition will be performed during various manoeuvers (radio-ulnar deviation, clenching fist, and dart-throwing motion).<br>Procedure: Arthrography<br>* percutaneous intra-articular injection of contrast media in the medio-carpal and radio-carpal joints<br>|
| Other: Wrist instability<br>Morphologic ligament changes (e.g. partial or complete rupture) Dynamic CT of the wrist will be performed before and after arthrography. | Device: Dynamic CT<br>* Various low dose CT acquisitions will be successively performed on the wrist to allow a four dimensional evaluation. The same type of acquisition will be performed during various manoeuvers (radio-ulnar deviation, clenching fist, and dart-throwing motion).<br>Procedure: Arthrography<br>* percutaneous intra-articular injection of contrast media in the medio-carpal and radio-carpal joints<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| scapholunate diastasis (mm) | The distance between the scaphoid bone and the lunate bone will be measured during all maneuvers performed | 1 day | 
| Scapholunate angle | the variation in the scapholunate angle during the maneuvers performed will be assessed | 1 day | 
| Lunocapitate angle | the variation in the lunocapitate angle during the maneuvers performed will be assessed | 1 day | 
| Posterior radio scaphoid angle | The angle formed between the posterior most point of the scaphoid in the sagittal plane and the ventral and dorsal rims of the distal radius will be assessed | 1 Day |