The real extent of damage in high-pressure injection injuries (grease gun injuries, paint gun injuries, pressure gun in juries) is hidden behind a small and frequently painless punctiform skin lesion on the finger or the hand. These kinds of injuries require prompt surgical intervention with surgical debridement of all ischemic tissue. Possibility of a general intoxication by the fluid must always be ruled out. Postoperative intensive physiotherapy is essential for the final hand function. The initial benign aspect is frequently causing a delay for an adequate treatment while in the mean time the possibility for subcutaneous damage continuously increases. Because of this delay the chance of permanent reduced functionality in the hand or finger amputation raises. Not only the latency time to adequate treatment but also the injected fluid's nature, the pressure, the volume and the location of injection, has influence on the seriousness and extensiveness of subcutaneous damage. All these factors influence the functional outcome of the patient.

We assessed the value of three‐compartment magnetic resonance (MR) wrist arthrography in comparison with non‐enhanced magnetic resonance imaging (MRI) for the evaluation of 13 individual wrist ligaments in 35 patients with refractory wrist pain. In 20 of these patients MR findings were correlated with the findings from multiportal wrist arthroscopy. For MR imaging (1.5‐T magnet) a three‐dimensional volume acquisition with a gradient‐recalled echo sequence and 0.6–1.0 mm effective slice thickness was used. The delineation of individual wrist ligaments was rated as “good” in 10% of non‐enhanced MR and 90% of MR arthrography images. Ligament evaluation was possible with high diagnostic confidence in 11% by non‐enhanced MR imaging and 90% by MR arthrography. With wrist arthroscopy as the standard of reference, average sensitivities/specificities/accuracies for the diagnosis of full‐thickness ligamentous defects were 0.81/0.75/0.77 for non‐enhanced MR imaging and 0.97/0.96/0.96 for MR arthrography. Our findings suggest that MR arthrography is more accurate than standard MRI in delineating and evaluating the ligaments of the wrist.J. Magn. Reson. Imaging 1999;9:468–474. © 1999 Wiley‐Liss, Inc.

MR arthrography, using three-dimensional volume acquisition with thin slices (0.6-1.0 mm), combines the advantages of three-compartment arthrography and non-enhanced MRI. It shows the precise location and magnitude of ligamentous defects of all parts of the SLIL, correlates well with wrist arthroscopy and has potential implications for diagnosis and treatment planning.

The authors studied botulinum toxin type A therapy of severe biceps-triceps cocontractions after nerve regeneration following birth-related brachial plexus lesions. Six children (age, 2 to 4 years) were treated two to three times over a period of 8 to 12 months with 40 mouse units of botulinum toxin at two sites of the triceps muscle. Elbow range of motion improved from 0 to 25 to 50 deg to 0 to 25 to 100 deg (p < 0.05), and muscle force of elbow flexion increased from a mean of Medical Research Council classification 1.7 to 3.7 (p < 0.05). After a 1-year follow-up, there was no clinical recurrence.

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