Ultrasound of the Hand and Wrist

Abstract

There have been immense technical innovations and broadened clinical applications of ultrasound in the musculoskeletal system over the past 20 years. Specifically with regard to the hand and wrist, the advent of higher resolution transducers and postprocessing software applications have resulted in overall enhanced visualization of soft tissue structures (tendons/ligaments) as well as surface osseous lesions such as subclinical erosions in rheumatoid arthritis. Quantitative ultrasound, using either power Doppler or contrast-enhanced imaging, has become a central outcomes measure used to evaluate and document patient response to treatment in inflammatory arthropathies such as rheumatoid arthritis. This review will summarize the current state of clinical applications of ultrasound in the evaluation of the hand and wrist, with a summary of technical advances and specific applications in rheumatologic conditions.This review was exempt from institutional review board approval.

Emergency and Trauma of Hand and Wrist

“…Technical advances enhance diagnostic accuracy and visibility of internal architecture of tendons and ligaments due to higher frequency transducers. 51 Excellent knowledge of anatomy in the fingers and hand is necessary for accurate evaluation of pathology.…”

“…52 US is especially helpful if MRI is contraindicated or unavailable. 51 Tendons are suitable for US evaluation with high-resolution probes due to their superficial position. Normal tendons retain a hyperechoic fibrillary pattern.…”

“…Normal tendons retain a hyperechoic fibrillary pattern. 51 Echogenicity depends on orientation and direction of the probe; this anisotropy provides falsely hypoechoic tendons if US beam does not interrogate the tendons at a 90-degree angle. 53 Dynamic assessment with flexion of the fingers can confirm flexor pully injuries.…”

Normal Sonographic Anatomy of the Wrist With Emphasis on Assessment of Tendons, Nerves, and Ligaments

“…As a cost‐effective, quick, and noninvasive imaging technique that also provides dynamic assessment, sonography is a valuable tool for examining the musculoskeletal system. Current ultrasound systems allow for visualization of the small superficial structures of the wrist with high resolution 3 , 4 . Since the wrist joint is complex, to avoid misdiagnosis, examiners should be familiar with normal findings and variants commonly depicted when evaluating the wrist.…”

“…Current ultrasound systems allow for visualization of the small superficial structures of the wrist with high resolution. 3,4 Since the wrist joint is complex, to avoid misdiagnosis, examiners should be familiar with normal findings and variants commonly depicted when evaluating the wrist. Here we review the normal and variant anatomy of the wrist and discuss the scanning techniques that are recommended to assess the soft tissue structures of the wrist, with particular emphasis given to tendons, nerves, and ligaments.…”