MRI Diagnostics of the Fingers: Current Developments and Clinical Relevance

Abstract

Background

Magnetic resonance imaging (MRI) is an excellent method for visualizing the complex anatomical structures of the fingers. The high diagnostic standard is based on numerous recent technical developments to improve soft tissue differentiation and detail recognition, and includes time-resolved functional imaging

Method

This review highlights the current status of MRI in finger diagnostics. The content of this narrative review is based on a literature search in the PubMed and Google Scholar databases using the search terms “finger MRI” and “finger imaging”.

Conclusion

Due to numerous technical optimizations and the increasing clinical availability of MRI, this examination has become indispensable in routine use for the further clarification of traumatic and orthopedic clinical pictures. MRI is also playing an increasingly important role in rheumatic and inflammatory issues, as well as tumors, whereby the particularly high potential for early detection and the detailed soft tissue imaging are especially advantageous.

Key Points

• MRI enables precise differential diagnosis of all clinical pictures of the fingers and is useful in the clarification of traumatic, orthopedic, rheumatic, inflammatory, and neoplastic issues.

• Multi-channel hand coils, scanners with high magnetic field strengths, and the use of contrast agents have led to an evaluation with resolutions in the submillimeter range in some cases.

• High-resolution MRI, including the possibility of functional examination, makes it easier to determine adequate therapy and avoid subsequent damage while meeting high standards.

Citation Format

• Bayer T, Lutter C, Janka R et al. MRI Diagnostics of the Fingers: Current Developments and Clinical Relevance. Rofo 2025; DOI 10.1055/a-2594-7451

Keywords

MRI - finger - trauma - tumor - inflammation

Publication History

Received: 14 March 2025

Accepted after revision: 10 April 2025

Article published online:
26 May 2025

• References

• 1 Schmidt HM, Lanz U. Chirurgische Anatomie der Hand. Stuttgart, New York: Thieme; 1992
• 2 Hentz VR. Functional anatomy of the hand and arm. Emerg Med Clin North Am 1985; 3: 197-220
• 3 Moran CA. Anatomy of the hand. Phys Ther 1989; 69: 1007-1013
• 4 Bayer T, Schweizer A, Muller-Gerbl M. et al. Proximal interphalangeal joint volar plate configuration in the crimp grip position. J Hand Surg Am 2012; 37: 899-905
• 5 Schmitt R. Ligament injuries of fingers and thumbs. Radiologe 2017; 57: 43-56
• 6 Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand – An Update on MRI. Rofo 2022; 194: 1307-1321
• 7 Hauger O, Chung CB, Lektrakul N. et al. Pulley system in the fingers: Normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 2000; 217: 201-212
• 8 Zafonte B, Rendulic D, Szabo RM. Flexor pulley system: anatomy, injury, and management. J Hand Surg Am 2014; 39: 2525-2532
• 9 Dalili D, Fritz J, Isaac A. 3D MRI of the Hand and Wrist: Technical Considerations and Clinical Applications. Semin Musculoskelet Radiol 2021; 25: 501-513
• 10 Bayer T. Finger injuries with a focus on ligamentous structures. Radiologe 2021; 61: 426-432
• 11 Bayer T, Bachter L, Lutter C. et al. Comparison of 3T and 7T magnetic resonance imaging for direct visualization of finger flexor pulley rupture: An ex-vivo study. Skeletal Radiol 2024; 53: 2469-2476
• 12 Heiss R, Librimir A, Lutter C. et al. MRI of Finger Pulleys at 7T-Direct Characterization of Pulley Ruptures in an Ex Vivo Model. Diagnostics (Basel) 2021; 11
• 13 Bayer T, Adler W, Janka R. et al. Magnetic resonance cinematography of the fingers: A 3.0 Tesla feasibility study with comparison of incremental and continuous dynamic protocols. Skeletal Radiol 2017; 46: 1721-1728
• 14 Lutter C, Kuerten S, Geppert C. et al. Dynamic study of the finger interphalangeal joint volar plate-motion analysis with magnetic resonance cinematography and histologic comparison. Skeletal Radiol 2023; 52: 1493-1501
• 15 Artiaco S, Bosco F, Lusso A. et al. Flexor Tendon Pulley Injuries: A Systematic Review of the Literature and Current Treatment Options. J Hand Microsurg 2023; 15: 247-252
• 16 Giese J, Cerniglia C. Soft Tissue Injuries of the Finger and Thumb. Semin Ultrasound CT MR 2018; 39: 397-410
• 17 Hesse N, Reidler P, Schmitt R. Sports-related injuries of the thumb and fingers. Radiologie (Heidelb) 2023; 63: 284-292
• 18 Petchprapa CN, Vaswani D. MRI of the Fingers: An Update. AJR Am J Roentgenol 2019; 213: 534-548
• 19 Kim YW, Roh SY, Kim JS. et al. Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes. Arch Plast Surg 2018; 45: 458-465
• 20 Gupta P, Lenchik L, Wuertzer SD. et al. High-resolution 3-T MRI of the fingers: Review of anatomy and common tendon and ligament injuries. AJR Am J Roentgenol 2015; 204: W314-323
• 21 Schoffl I, Oppelt K, Jungert J. et al. The influence of the crimp and slope grip position on the finger pulley system. J Biomech 2009; 42: 2183-2187
• 22 Schweizer A. Biomechanical properties of the crimp grip position in rock climbers. J Biomech 2001; 34: 217-223
• 23 Goncalves-Matoso V, Guntern D, Gray A. et al. Optimal 3-T MRI for depiction of the finger A2 pulley: Comparison between T1-weighted, fat-saturated T2-weighted and gadolinium-enhanced fat-saturated T1-weighted sequences. Skeletal Radiol 2008; 37: 307-312
• 24 Guntern D, Goncalves-Matoso V, Gray A. et al. Finger A2 pulley lesions in rock climbers: Detection and characterization with magnetic resonance imaging at 3 Tesla--initial results. Invest Radiol 2007; 42: 435-441
• 25 Bayer T, Fries S, Schweizer A. et al. Stress examination of flexor tendon pulley rupture in the crimp grip position: A 1.5-Tesla MRI cadaver study. Skeletal Radiol 2015; 44: 77-84
• 26 Bayer T, Adler W, Schweizer A. et al. Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol 2015; 44: 1279-1285
• 27 Clavero JA, Alomar X, Monill JM. et al. MR imaging of ligament and tendon injuries of the fingers. Radiographics 2002; 22: 237-256
• 28 Bayer T, Schoffl VR, Lenhart M. et al. Epiphyseal stress fractures of finger phalanges in adolescent climbing athletes: A 3.0-Tesla magnetic resonance imaging evaluation. Skeletal Radiol 2013; 42: 1521-1525
• 29 El-Sheikh Y, Lutter C, Schoeffl I. et al. Surgical Management of Proximal Interphalangeal Joint Repetitive Stress Epiphyseal Fracture Nonunion in Elite Sport Climbers. J Hand Surg Am 2018; 43: 572 e571-572 e575
• 30 Sims LA. Upper Extremity Injuries in Rock Climbers: Diagnosis and Management. J Hand Surg Am 2022; 47: 662-672
• 31 Boulas HJ, Milek MA. Hook of the hamate fractures. Diagnosis, treatment, and complications. Orthop Rev 1990; 19: 518-529
• 32 Milek MA, Boulas HJ. Flexor tendon ruptures secondary to hamate hook fractures. J Hand Surg Am 1990; 15: 740-744
• 33 Prokop M, Schneider G, Vanzulli A. et al. Contrast-enhanced MR Angiography of the renal arteries: Blinded multicenter crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine. Radiology 2005; 234: 399-408
• 34 den Hollander NK, Verstappen M, Sidhu N. et al. Hand and foot MRI in contemporary undifferentiated arthritis: In which patients is MRI valuable to detect rheumatoid arthritis early? A large prospective study. Rheumatology (Oxford) 2022; 61: 3963-3973
• 35 Schueller-Weidekamm C, Lodemann KP, Grisar J. et al. Contrast-enhanced MR imaging of hand and finger joints in patients with early rheumatoid arthritis: Do we really need a full dose of gadobenate dimeglumine for assessing synovial enhancement at 3 T?. Radiology 2013; 268: 161-169
• 36 Tani C, D’Aniello D, Possemato N. et al. MRI pattern of arthritis in systemic lupus erythematosus: A comparative study with rheumatoid arthritis and healthy subjects. Skeletal Radiol 2015; 44: 261-266
• 37 Cimmino MA, Barbieri F, Boesen M. et al. Dynamic contrast-enhanced magnetic resonance imaging of articular and extraarticular synovial structures of the hands in patients with psoriatic arthritis. J Rheumatol Suppl 2012; 89: 44-48
• 38 Cimmino MA, Parodi M, Zampogna G. et al. Dynamic contrast-enhanced, extremity-dedicated MRI identifies synovitis changes in the follow-up of rheumatoid arthritis patients treated with rituximab. Clin Exp Rheumatol 2014; 32: 647-652
• 39 Renner N, Kleyer A, Kronke G. et al. T2 Mapping as a New Method for Quantitative Assessment of Cartilage Damage in Rheumatoid Arthritis. J Rheumatol 2020; 47: 820-825
• 40 Horcajadas AB, Lafuente JL, de la Cruz Burgos R. et al. Ultrasound and MR findings in tumor and tumor-like lesions of the fingers. Eur Radiol 2003; 13: 672-685
• 41 Stacy GS, Bonham J, Chang A. et al. Soft-Tissue Tumors of the Hand-Imaging Features. Can Assoc Radiol J 2020; 71: 161-173
• 42 Mundada P, Becker M, Lenoir V. et al. High resolution MRI of nail tumors and tumor-like conditions. Eur J Radiol 2019; 112: 93-105