Dynamic radiographic evaluation of obscure wrist pain in the teenage patient.

Chronic wrist pain in the teenage patient constitutes a diagnostic challenge. Carpal instability patterns and internal joint derangements may be difficult to diagnose by physical examination and conventional plain radiographs. Dynamic radiographic studies frequently provide a better understanding of abnormal wrist mechanics. We reviewed our experience with fluoroscopy and radiocarpal arthrography in 14 teenage patients with chronic wrist pain. Videotape fluoroscopy was performed in all 14 patients. Dynamic radiocarpal arthrography was then performed in 10 patients in whom fluoroscopic findings were normal or more information was needed. These imaging methods led to a diagnosis in 64% of the patients and excluded a significant anatomic carpal abnormality in the other patients. In the teenage patient, internal derangements of the intercarpal ligaments are usually posttraumatic rather than attritional in origin. Dynamic radiographic techniques provide an accurate means for the diagnosis of these specific anatomic carpal abnormalities.