Role of High-Resolution Sonography in the Evaluation of Non-Traumatic Wrist Joint Pain and Correlation with MRI Findings

Abstract

Background: Non-traumatic wrist pain is a common clinical problem caused by a variety of conditions including tendinopathy, ganglion cysts, arthritis, carpal tunnel syndrome (CTS), solid masses, and triangular fibrocartilage complex (TFCC) tears. Magnetic Resonance Imaging (MRI) is considered the gold standard for evaluating wrist pathologies; however, its cost and limited availability may restrict routine use. High-resolution ultrasonography (USG) offers a rapid, non-invasive, and cost-effective alternative. This study evaluated the effectiveness of USG in diagnosing non-traumatic wrist pain and correlated its findings with MRI.

Methods: A descriptive observational cross-sectional study was conducted in the Department of Radiodiagnosis, Murshidabad Medical College and Hospital, West Bengal. Eighty patients presenting with non-traumatic wrist pain were included using purposive sampling. All participants underwent both high-resolution ultrasonography and MRI examination. MRI findings were considered the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s kappa statistic were calculated to assess the diagnostic performance and agreement of USG with MRI.

Results: The mean age of participants was 43.2±12.3 years, with females constituting 55% of the study population. MRI identified tendinopathy (26.3%) as the most common pathology, followed by ganglion cysts (20.0%), arthritis (16.3%), solid masses (15.0%), CTS (13.8%), and TFCC tears (8.8%). Ultrasound demonstrated high sensitivity and specificity for tendinopathy (95.2%, 100%), ganglion cysts (93.8%, 100%), and solid masses (100%, 100%). Moderate sensitivity was observed for arthritis (69.2%) and CTS (72.7%). Ultrasound showed poor sensitivity for TFCC tears (14.3%), although specificity remained 100%. Overall agreement between USG and MRI was substantial (Cohen’s κ = 0.78), with concordant findings in 81.3% of cases.

Conclusion: High-resolution ultrasonography is an effective first-line imaging modality for evaluating non-traumatic wrist pain, particularly for tendinopathy, ganglion cysts, and solid masses. Despite its limitations in detecting TFCC tears and certain deep intra-articular lesions, its high diagnostic accuracy, accessibility, and cost-effectiveness support its routine use, with MRI reserved for complex or inconclusive cases.