Please login to view this media
- Talk
- 21/09/2022
- UK
Dynamic (4DCT) Imaging of the DRUJ - Diagnosing Instability
Description
The presentation provided by Alex Overton, an ST6 trainee on the UCLH rotation, delves into a pilot study aimed at evaluating the feasibility of dynamically imaging the distal radioulnar joint (DRUJ). Overton illustrates that DRUJ instability can typically manifest as pain or a clunking sensation during lifting tasks, yet diagnosing it effectively remains a challenge due to clinical tests lacking sensitivity and often being subjective. The dynamic nature of DRUJ pathology complicates assessment using static imaging techniques, prompting the exploration of a novel four-dimensional imaging method that combines both cross-sectional and dynamic assessments.
The presentation goes on to detail the methodology employed in this study, which involved coaching and consenting patients prior to a procedure using a custom protocol with low radiation exposure compared to conventional imaging techniques. Patients were required to assume various wrist positions while dynamic imaging was recorded over the course of a pronation-supination cycle.
Through the application of the subluxation ratio method—one of three established techniques to measure joint instability—the study collected data focusing on differences between healthy and symptomatic wrists. The patient cohort was small, comprising predominantly female participants. Images obtained demonstrated significant displacement in the ulnar bone during wrist movement, supporting the technique’s effectiveness in revealing pathological variations.
Challenges faced included time-consumption during imaging and reporting, metal artifacts from previous surgeries impacting image quality, and issues related to inter-observer variability. Future phases of the study plan to incorporate standardized jigs to improve rotation accuracy and possibly utilize automated software for data collection.
In conclusion, Overton emphasizes that this innovative imaging technique could revolutionize the assessment of DRUJ stability, aiding in more targeted surgical interventions and reducing unnecessary anesthetic examinations. He notes that plans are underway for a larger cohort study to further explore the implications of this dynamic imaging modality on clinical practice.