Musculoskeletal ultrasound of the wrist
- Blake Reid Boggess, DO, FAAFP
Blake Reid Boggess, DO, FAAFP
- Associate Professor of Orthopedic Surgery
- Duke Sports Medicine Team Physician
- Duke University Medical Center
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
The wrist and proximal hand are susceptible to a variety of injuries and conditions. Due to the relatively superficial location of many wrist and hand structures, many of these pathologic conditions can be diagnosed or assessed using ultrasound (US).
This topic will review a standard, systematic approach to musculoskeletal ultrasonography of the wrist and proximal hand. Topics devoted to conditions and injuries involving the wrist and hand pain are found separately. (See "Evaluation of the adult with subacute or chronic wrist pain" and "Evaluation of the adult with acute wrist pain" and "History and examination of the adult with hand pain".)
USES, ADVANTAGES, AND LIMITATIONS OF WRIST AND HAND ULTRASOUND
Musculoskeletal ultrasound (US) uses high frequency sound waves (1 to 20 megahertz, MHz) to produce high-resolution images of soft-tissue structures (eg, nerves, tendons, muscles, ligaments, bursae) and bony surfaces. The basic physical principles and underlying technology of US are reviewed in detail separately. (See "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology".)
US has many advantages over other imaging modalities, including portability and point of care diagnosis . Many of these general advantages are discussed separately. (See "Musculoskeletal ultrasound of the shoulder", section on 'Uses, advantages, and limitations of shoulder ultrasound'.)
For evaluation of the wrist and proximal hand in particular, US offers the ability to visualize small joints and articulations, and adjacent structures, both statically and dynamically (ie, visualize while the joint or articulation is manipulated) with resolution that is the equal of (or sometimes superior to) magnetic resonance imaging (MRI). Imaging of structures like the median nerve or the ulnar collateral ligament of the thumb can be performed in a number of ways from different perspectives, providing sufficient diagnostic accuracy to forego additional diagnostic testing. As an example, serial measurements of the circumferential volume of the median nerve obtained using short-axis US views can demonstrate areas of enlargement or compression, while long-axis views can confirm the appearance of the nerve and the site of compression. These measurements enable the clinician to diagnose carpal tunnel syndrome with an accuracy comparable to electrodiagnostic testing .
- Smith J, Finnoff JT. Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals. PM R 2009; 1:64.
- Cartwright MS, Hobson-Webb LD, Boon AJ, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve 2012; 46:287.
- Chiou HJ, Chang CY, Chou YH, et al. Triangular fibrocartilage of wrist: presentation on high resolution ultrasonography. J Ultrasound Med 1998; 17:41.
- American College of Radiology (ACR), Society for Pediatric Radiology (SPR), Society of Radiologists in Ultrasound (SRU). AIUM practice guideline for the performance of a musculoskeletal ultrasound examination. J Ultrasound Med 2012; 31:1473.
- Klauser AS, Tagliafico A, Allen GM, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol 2012; 22:1140.
- www.essr.org/html/img/pool/wrist.pdf (Accessed on April 07, 2016).
- Jamadar DA, Jacobson JA, Hayes CW. Sonographic evaluation of the median nerve at the wrist. J Ultrasound Med 2001; 20:1011.
- Parellada AJ, Morrison WB, Reiter SB, et al. Flexor carpi radialis tendinopathy: spectrum of imaging findings and association with triscaphe arthritis. Skeletal Radiol 2006; 35:572.
- Jacobson JA. Wrist and hand ultrasound. In: Fundamentals of Musculoskeletal Ultrasound, 2nd ed, Elsevier Saunders, Philadelphia 2013. p.120.
- Martinoli C, Derchi LE, Pastorino C, et al. Analysis of echotexture of tendons with US. Radiology 1993; 186:839.
- Daenen B, Houben G, Bauduin E, et al. Sonography in wrist tendon pathology. J Clin Ultrasound 2004; 32:462.
- Backhaus M, Burmester GR, Gerber T, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60:641.
- Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32:2485.
- Rubin JM, Bude RO, Carson PL, et al. Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US. Radiology 1994; 190:853.
- Klauser AS, Faschingbauer R, Bauer T, et al. Entrapment neuropathies II: carpal tunnel syndrome. Semin Musculoskelet Radiol 2010; 14:487.
- Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol 2013; 17:28.
- USES, ADVANTAGES, AND LIMITATIONS OF WRIST AND HAND ULTRASOUND
- WRIST AND HAND ANATOMY FOR ULTRASOUND EXAMINATION
- Orientation and terminology
- Structures that can be imaged
- ULTRASOUND EXAMINATION OF THE WRIST AND HAND
- Guidelines, structures to image, and positioning
- Volar wrist and hand-midline
- Volar wrist and radial hand
- Volar wrist and ulnar hand
- Dorsal wrist and hand
- SONOGRAPHIC PITFALLS AND APPEARANCE OF WRIST AND HAND PATHOLOGY
- Synovial hypertrophy and cortical irregularities
- Carpal tunnel syndrome
- Ulnar collateral ligament of the thumb
- ADDITIONAL ULTRASOUND RESOURCES
- SUMMARY AND RECOMMENDATIONS