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Direct Arthrography of the Pisotriquetral Joint

Eric Pessis1, Jean-Luc Drapé2, Fabienne Bach2, Antoine Feydy2, Henri Guerini2 and Alain Chevrot2

1 Department of Radiology, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint Denis 93200, France.
2 Department of Radiology B, CHU Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V, Paris, France.


Figure 1
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  		Fig. 1A —26-year-old man. Pisotriquetral joint arthrograms with normal findings show no communication between radiocarpal joint and pisotriquetral joint. Posteroanterior view.

 

Figure 2
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  		Fig. 1B —26-year-old man. Pisotriquetral joint arthrograms with normal findings show no communication between radiocarpal joint and pisotriquetral joint. Supine oblique view.

 

Figure 3
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  		Fig. 2 —33-year-old woman. Position of hand for direct arthrography of pisotriquetral joint. Hand is overpronated, with mild palmar flexion. Dorsal surface of thumb is placed on table. Central beam (arrow) is perpendicular to table and centered on pisotriquetral joint.

 

Figure 4
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  		Fig. 3A —47-year-old man. Direct access of pisotriquetral joint under fluoroscopic guidance, with hand in extreme prone position. P = pisiform bone, T = triquetral bone. With dorsal flexion of wrist, pisotriquetral joint space is narrowed (arrow).

 

Figure 5
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  		Fig. 3B —47-year-old man. Direct access of pisotriquetral joint under fluoroscopic guidance, with hand in extreme prone position. P = pisiform bone, T = triquetral bone. With mild palmar flexion of wrist, pisotriquetral joint space is enlarged (asterisk).

 

Figure 6
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  		Fig. 3C —47-year-old man. Direct access of pisotriquetral joint under fluoroscopic guidance, with hand in extreme prone position. P = pisiform bone, T = triquetral bone. 23-gauge butterfly needle is positioned directly in joint space. Correct positioning of needle is confirmed arthrographically by progressive filling of pisotriquetral joint.

 

Figure 7
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  		Fig. 4A —58-year-old woman. Direct access of pisotriquetral joint under fluoroscopic guidance. P = pisiform bone, T = triquetral bone. Oblique view of wrist shows advanced osteoarthritis of pisotriquetral joint with narrowing of joint space. Needle position is modified as necessary toward distal surface of joint (asterisk) to avoid narrowed pisotriquetral joint space.

 

Figure 8
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  		Fig. 4B —58-year-old woman. Direct access of pisotriquetral joint under fluoroscopic guidance. P = pisiform bone, T = triquetral bone. Correct positioning of needle is confirmed arthrographically by progressive filling of pisotriquetral joint.

 

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