Identification of degenerative precursors at the wrist with advanced imaging: current updates

Articular malalignment and ulnocarpal impaction can progress to osteoarthritis in the wrist. This may be triggered by tears of the scapholunate ligament (rarely the lunotriquetral ligament) or the foveal lamina of the triangular fibrocartilage complex. In the pre-degenerative stages, radiographic findings are inconclusive, and symptoms may be absent or discrete. Similarly, positive ulnar variance may be associated with symptoms that are at first mild and without radiographic abnormalities. This review presents imaging findings in the early stages before carpal osteoarthritis or impaction syndrome develops. Ligament tears, chondromalacia and focal bone marrow oedema are identified using magnetic resonance imaging as well as magnetic resonance and computed tomography arthrography. Identifying these precursors may allow raise awareness of subtle imaging findings in the wrist that may progress to instability, degeneration or osteoarthritis and allow appropriate patient counselling.