MRI has a significant role in the diagnosis and as-sessment of soft tissue masses in the hand and WRIST. Radiograph and CT scan remain useful in some cases. However, the potential detection rate and high soft tissue contrast resolution permit a valuable and more significant role for MRI in the evaluation and in certain cases tissue characterization of soft tissue masses in the hand and WRIST. In this session we would like to discuss MRI features and findings of the common soft tissue tumors in the hand and WRIST.

Background: Functional Magnetic resonance imaging (fMRI) measures the small fluctuation of blood flow happening during task-fMRI in brain regions. Objective: This research investigated these active, imagery and passive movements in volunteers design to permit a comparison of their capabilities in activating the brain areas. Material and Methods: In this applied research, the activity of the motor cortex during the right-WRIST movement was evaluated in 10 normal volunteers under active, passive, and imagery conditions. T2* weighted, three-dimensional functional images were acquired using a BOLD sensitive gradient-echo EPI (echo planar imaging) sequence with echo time (TE) of 30 ms and repetition time (TR) of 2000 ms. The functional data, which included 248 volumes per subject and condition, were acquired using the blocked design paradigm. The images were analyzed by the SPM12 toolbox, MATLAB software. Results: The findings determined a significant increase in signal intensity of the motor cortex while performing the test compared to the rest time (p< 0. 05). It was also observed that the active areas in hand representation of the motor cortex are different in terms of locations and the number of voxels in different WRIST directions. Moreover, the findings showed that the position of active centers in the brain is different in active, passive, and imagery conditions. Conclusion: Results confirm that primary motor cortex neurons play an essential role in the processing of complex information and are designed to control the direction of movement. It seems that the findings of this study can be applied for rehabilitation studies.

Schwannoma’, s are benign tumors that can affect all nerves even the peripheric nerve. In the present study, a 66 year old case (man) which had a mass upon his WRIST with a diagnostic delay of two years has been studied. Diagnosis was based on imaging features (Ultrasonography and MRI) with Electromyography (EMG) which was assessed by histopathological examination.

Objective: WRIST trauma is a common chief complaint in emergency departments and radiography is used to make the diagnosis. Excessive usage of radiographs would utilize resources, exert risk of radiation exposure, and overcrowding. Amsterdam WRIST rules (AWR) have been proposed as a tool for clinical decision-making regarding the need for WRIST fracture diagnosis. This study assessed the diagnostic test performance of this rule in WRIST trauma for WRIST fracture. Methods: All patients over 18 years old with the chief complaint of acute WRIST trauma were included. They were excluded if Glascow coma scale (GCS) was below 15, needed emergency surgery without an X-ray, and had a history of WRIST fracture in the past 3 months. Anteroposterior and lateral radiographs were obtained and the AWR predictors were assessed before going to the radiology unit. The presence of a fracture of the distal radius was confirmed by treating emergency physician or radiologist. Results: 205 participants were recruited in this study, of which 6 patients (2.9%) were excluded due to missing data. The median age was 40 (IQR: 30-50) and 74 (37.2%) patients were female. There were 66 (33.2%) patients with a WRIST fracture, which distal radius accounted for most of them. The AWR had sensitivity and specificity of 0.71 (95% CI: 0.49,0.87) and 1 (95% CI: 0.92,1), respectively. Although the negative likelihood ratio of AWR was 0.29 (95% CI: 0.16,0.54), the positive likelihood ratio was infinite. The positive predicted value was 1 (95% CI:  0.80,1), whereas the negative predictive value was 0.86 (95% CI: 0.74,0.94). Conclusion: The AWR showed great specificity and positive predictive. It had fair sensitivity, negative predictive value, and negative likelihood ratio for diagnosis of WRIST fracture in patients with WRIST trauma.

Background: Magnetic resonance imaging (MRI) of the WRIST joint is a useful method in the diagnosis of triangular fibrocartilage complex (TFCC), ligaments and tendons, peripheral nerves, cartilage and carpal tunnel syndrome. However, the evaluation of these small anatomical structures is a topic of investigation. In some instances, the diagnostic indices of MRI in tears and other lesions of cartilage and ligamentous structures are relatively low, so the protocols should be optimized. Objectives: In this study, we aim to compare new MRI protocols of 3D T2SPACE, PD BLADE and T2 BLADE with the conventional protocols, including T2 FSE, PD FSE, and T1 FSE in case of signal intensity. Patients and Methods: Twenty patients with a history of WRIST trauma or suspected WRIST lesions were referred by orthopedic hand surgeons and enrolled into the study. All the protocols were carried out on all patients and the images were assessed quantitatively by measurement of signal to noise ratio (SNR) and contrast to noise ratio (CNR). Then, these parameters were compared between different protocols. SPSS ver. 18 was used for the statistical analyses. Results: SNR of the cartilage, TFCC on 3D T2SPACE and T1 FSE was better than other sequences (P < 0. 001). SNR of the bone on PD BLADE was significantly higher (P < 0. 001) than that of conventional protocols. PD BLADE images showed significantly higher bonecartilage CNR and bone-TFCC CNR (P < 0. 001 to P < 0. 001). CNR of cartilage-TFCC on T1 FSE was better than other sequences, but no significant statistical differences were seen. Conclusion: High-resolutionMRImages of the WRIST using 3D T2SPACE, PDBLADE andT2 BLADE were superior to those using conventional sequences quantitatively. High-SNR and CNR MR imaging with SPACE and BLADE would be a promising method to diagnose WRIST lesions.

WRIST involvement is common in patients with rheumatoid arthritis. Individual patient assessment is important in determining functional deficits and treatment goals. Patients with persistent disease despite aggressive medical management are candidates for surgery. Soft-tissue procedures offer good symptomatic relief and functional improvement in short term. Extensor and flexor tendons may rupture because of synovial infiltration and bony irritation. When rupture occurs, direct repair usually is not possible. However, when joints that are motored by the ruptured tendon are still functional, tendon transfer or grafting may be considered. Because of the progressive nature of the disease, dislocation and end-stage arthritis often require stabilization with bony procedures. The distal radioulnar joint is usually affected first and is commonly treated with either the Darrach or the Sauvé-Kapandji procedure. Partial WRIST fusion offers a compromise between achieving stability of the affected radiocarpal joint and maintaining motion at the midcarpal joint. For pancarpal arthritis, total WRIST fusion offers reliable pain relief at the cost of motion. Total WRIST arthroplasty is an alternative that preserves motion; however, the outcomes of total WRIST replacement are still being evaluated.

Background: WRIST arthroscopy is an evolving diagnostic and therapeutic modality which is progressively used by Iranian surgeons. Little data is published about the procedure’s indications, outcomes, complications and prognostic factors. In following study we evaluate the outcome and complications of diagnostic and therapeutic arthroscopy in our patients.Methods: In a prospective study from September 2009 to March 2013, 100 patients entered in the study. All the patients had chronic WRIST pain without any sign of improvement despite at list three months non-operative treatment and underwent diagnostic and therapeutic WRIST arthroscopy. All patients were evaluated by WRIST range of motion, visual analogue scale (VAS), the quick-disabilities of the arm, shoulder and hand (QDASH), and Mayo WRIST functional score before and after arthroscopy. Patients were visited at 3, 6, 12 weeks intervals after surgery and every six months thereafter. The most frequent diagnoses were triangular fibrocartilage complex (TFCC) injury, dorsal WRIST ganglion cyst and Kienbock disease which were treated with accordant arthroscopic methods. Major and minor complications of arthroscopy and prognostic factors were evaluated.Results: Eighty nine patients participated in long term follow-up. The follow-up duration was 19±13 months. At final fallow-up there were 28.6±9.6 degrees improvement in WRIST range of motion, 5.1±3.4 reduction in VAS score (P<0.04), 37.9±30 improvement in Mayo functional WRIST score (P<0.02) and 47.5±33 reduction in Q-DASH score (P=0.009).82% of patients were satisfied with postoperative results and 16% experienced recurrence. The preoperative diagnosis was not a prognostic factor for outcome of arthroscopic treatment. The rate of postoperative complications was 31.4%, which most of them were minor and transient complications. The most frequent complication of WRIST arthroscopy in our patients was transient hypoesthesia in superficial ulnar nerve territory.Conclusion: According to our results, WRIST arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with WRIST arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.

fusion following the studies by FIFA (Federation Internationale de Football Associations). Research using images other than T1WI has not been reported. The aim of this study is to evaluate the grade of epiphyseal fusion by T2* weighted images (T2*WI) and to investigate new findings on T2*WI as compared with T1WI.Methods: A total of 87 subjects, all junior football players between the ages of 12 and 17 years old, were examined. T1 and T2* WI were obtained using a 1.2T Open type MR system. The T1WI and T2*WI were rated twice randomly by four radiologists using the FIFA grading system.Results: The intra-rater reliability for grading was higher in T1WI (The Intraclass Correlation Coefficient (ICC)=0.949-0.985) than in T2*WI (ICC=0.917-0.943). The inter-rater reliability for grading was also higher in T1WI (ICC=0.923) than in T2*WI (ICC=0.867).Conclusions: This research showed that T1WI is a better sequence than T2*WI to evaluate bone fusion following FIFA protocol. It was speculated that the reason for this is that T1WI has higher tissue contrast resolution and enables clearer images of the epiphyseal fusion than T2*WI and the grading system by T1WI was not suitable for T2*WI.

Objective: The aim of this survey is to determine of emergency management of spaghetti WRIST functional impairments due to these injuries which demands an adequate and accurate management of such injuries. Materials & Methods: All the Patients with Spaghetti WRIST (33 Persons) due to sharp injuny that was operated by one surgeon, presenting to hand Rehabilitation center whom includeded in this study, all of them were managed with early intervention programs by one therapist for 10 weeks, and they were assessed with mono semmes – weinstein mono filament asterwards.The effects of sex, age, time of surgery and outcomes were assessed. Results: Thirty-three Patients were included in this survey. In evaluation of median nerve in the given time, non of them were not tested and 40/31% of them had diminished quality of light touch. In ulnar nerve impairoment 43/7% had diminished protective touch and in Pinch Grip evaluation we found that both unlar and median nerve injuries has most affect in increasing the power. Conclusion: early surgery and early intervention has the best effect on spaghetti WRIST Motor and sensory recovery found to be better in madian nevere injuries versus ulnar nerve ones.

Background: Rice bodies can be found in rheumatic diseases, infectious diseases, and osteoarthritic joints. Rice bodies' most common locations include the subacromial bursa of the shoulder and the knee, while rice body synovitis of the WRIST extensor tendons is uncommon. We have presented the case of tuberculous tenosynovitis with rice body formation in the extensor tendon sheaths of the hand and WRIST. Case Report: A 51-year-old man presented with swelling and mild pain in the dorsal side of left WRIST, hand, and proximal phalanx of the second finger. He stated a history of traumatic injury to the proximal phalanx of the index finger. Radiographs showed a soft-tissue mass shadow, and magnetic resonance imaging (MRI) showed edema and soft tissue swelling around extensor tendons extending into the distal forearm and ulnar side of the second finger in favor of tenosynovitis. Laboratory test results were normal. The patient had a negative Mantoux test result and no history of mycobacterial exposure. Surgical exploration of the lesion revealed rice bodies in the synovial sheath of extensor tendons in the WRIST, extending distally to the dorsal aspect of the hand, especially the radial side. Removal of the rice bodies and complete excision of the sheath and tenosynovectomy was performed. Conclusion: As in our case, even in the absence of past tuberculosis (TB) infection or exposure, Mycobacterium TB (MTB) should be considered in the differential diagnosis of long-standing extensor tenosynovitis in the hand and WRIST.