About a wrist MR arthrogram
The wrist is made up of eight small carpal bones held together by many small ligaments. Two of the most important are the scapholunate ligament, which joins the scaphoid and lunate bones, and the lunotriquetral ligament. On the little-finger side of the wrist sits the triangular fibrocartilage complex (TFCC), a cushion of cartilage and ligaments that supports the joint. Injuries to these structures, often from a fall on an outstretched hand or twisting, can cause long-lasting wrist pain, clicking and weakness.
Because these structures are very small, they can be hard to see on X-ray and standard MRI. In an MR arthrogram, contrast dye is injected into the wrist before the MRI, which outlines the ligaments and cartilage and can show tears more clearly. In one study comparing wrist MR arthrograms with arthroscopy (keyhole surgery), the arthrogram detected around 9 in 10 TFCC and scapholunate ligament tears. This can help your specialist decide whether you need surgery or can be treated with rehabilitation. Left and right wrists are separate scans.
What happens during the scan
An MR arthrogram is done in two parts. First, a small amount of contrast dye (gadolinium) is injected directly into the wrist joint. The skin is cleaned and numbed with local anaesthetic, and the needle is guided into the joint using X-ray (fluoroscopy) or ultrasound. You may feel a sharp scratch, some pressure and a feeling of fullness in the joint, but it should not be painful. You will then be asked to move the joint gently to spread the dye.
Shortly afterwards you have the MRI scan. You lie still on the scanner bed with the wrist in a coil while the pictures are taken; the scan itself usually takes about 20–40 minutes. The scanner is loud, so you will wear ear plugs or headphones, and the radiographer can talk to you throughout. Allow up to 1½ hours for the whole appointment.
Referral needed: this scan requires a referral from a specialist, such as an orthopaedic surgeon, sports medicine doctor or specialist physiotherapist. You can upload the referral when you book.
What the scan can show
A wrist MR arthrogram can help to look at:
- tears of the triangular fibrocartilage complex (TFCC)
- scapholunate and lunotriquetral ligament tears
- damage to the joint cartilage
- persistent, unexplained wrist pain after an injury
- the wrist before or after keyhole surgery
No scan picks up every small tear, so your specialist will look at the results together with your symptoms and examination.
Preparing for your scan
No special preparation is usually needed, and you can eat and drink normally. Because the injection goes into a joint, tell us when booking if you take blood-thinning medicines, have a skin infection near the joint, have kidney problems or have had a reaction to contrast dye. Arrange for someone else to drive you home, as you should not drive for 24 hours afterwards.
You may be asked to remove rings and watches from the hand being scanned. If you wear a wrist splint, bring it with you.
You can usually eat, drink and take your normal medicines unless the scanning centre tells you otherwise. Wear loose, comfortable clothing without metal zips or buttons, and leave jewellery at home. You will be asked to remove metal items such as hair clips, hearing aids, coins and keys, and you may be asked to change into a gown.
Before the scan you will complete a safety questionnaire. Tell the team if you have a pacemaker, any metal implant, surgical clips or other device, if you have kidney problems or allergies, or if you are, or might be, pregnant or breastfeeding. If you feel anxious in enclosed spaces, let us know when you book. Some centres can offer a relaxant, and if you take one you will need someone to take you home and must not drive for 24 hours.
After the arthrogram
The joint may feel stiff, swollen or full, and you may hear it creak or gurgle as you move it. This usually settles within 48 hours. Keep the joint moving gently, but avoid vigorous exercise for at least 24 hours. An ice pack and a simple painkiller can help. Do not drive for 24 hours after the injection. Contact your GP or NHS 111 if the joint becomes increasingly painful, red, hot or swollen, or if you develop a fever, as infection, although rare, needs prompt treatment.
Frequently asked questions
Do I need a referral for an MR arthrogram of the wrist?
Yes. This scan requires a referral from a specialist. Please upload your referral when you book so the scanning centre can check that an arthrogram is the right test for you.
What is the difference between an MRI and an MR arthrogram?
A standard MRI is taken without anything being injected into the joint. In an MR arthrogram, contrast dye is injected into the joint first. The dye fills the joint and outlines the cartilage, ligaments and other structures, which can show small tears that a standard MRI may not.
Is the injection painful?
The skin is numbed with local anaesthetic first, so most people feel only a sharp scratch and some pressure. The joint may feel full or stiff for a day or two afterwards.
Can I drive home afterwards?
No. You should not drive for 24 hours after the injection, so please arrange for someone to take you home.
What is a TFCC tear?
The triangular fibrocartilage complex (TFCC) is a cushion of cartilage and ligaments on the little-finger side of the wrist. A tear, often from a fall or twisting injury, can cause pain on that side of the wrist, especially when turning the forearm or gripping.
Sources
- RadiologyInfo.org – Arthrography
- United Lincolnshire Hospitals NHS – MRI Arthrogram
- Mahmood A. et al. – Wrist MRI Arthrogram v Wrist Arthroscopy: What are we Finding? (The Open Orthopaedics Journal, 2012)
- NHS – MRI scan
The information on this page has been gathered from various sources and is provided for general information only. It is not medical advice. TOP MRI is not liable for the accuracy or completeness of this information. Please speak to your doctor or the scanning centre about your own situation.