ABSTRACT
With adequate equipment, training, and expertise, ultrasound (US) should be regarded
as the first-line imaging modality for the assessment of a wide range of pathological
conditions affecting the soft tissues around the wrist and hand. With high-resolution
transducers, US allows detection of foreign bodies and a reliable identification of
a variety of traumatic lesions affecting tendons, retinacula and annular pulleys,
ligaments, vessels, and nerves. In addition, inflammatory arthropathies, infectious
disorders, overuse tendinopathies, and degenerative conditions can be diagnosed with
this technique. In the wrist, US is able to identify the entrapment of the median,
ulnar, and radial nerves. In patients with localized soft tissue swelling, US is able
to assess the presence of a space-occupying lesion and to characterize its nature
in many cases.
KEYWORDS
Ultrasound - hand - wrist
REFERENCES
- 1
Bianchi S, Martinoli C, Abdelwahab I F.
High-frequency ultrasound examination of the wrist and hand.
Skeletal Radiol.
1999;
28
121-129
- 2
Teefey S A, Middleton W D, Boyer M I.
Sonography of the hand and wrist.
Semin Ultrasound CT MR.
2000;
21
192-204
- 3
Middleton W D, Teefey S A, Boyer M I.
Hand and wrist sonography.
Ultrasound Q.
2001;
17
21-36
- 4
Lee D.
Sonography of the wrist and hand.
Semin Musculoskelet Radiol.
1998;
2
237-244
- 5
Read J W, Conolly W B, Lanzetta M, Spielman S, Snodgrass D, Korber J S.
Diagnostic ultrasound of the hand and wrist.
J Hand Surg [Am].
1996;
21
1004-1010
- 6
Corduff N, Jones R, Ball J.
The role of ultrasound in the management of zone-1 flexor tendon injuries.
J Hand Surg [Br].
1994;
19
76-80
- 7
Dao K D, Solomon D J, Shin A Y, Puckett M L.
The efficacy of ultrasound in the evaluation of dynamic scapholunate ligamentous instability.
J Bone Joint Surg Am.
2004;
86
1473-1478
- 8
Boutry N, Lapegue F, Masi L, Claret A, Demondion X, Cotten A.
Ultrasonographic evaluation of normal extrinsic and intrinsic carpal ligaments: preliminary
experience.
Skeletal Radiol.
2005;
34
513-521
- 9
Finlay K, Lee R, Friedman L.
Ultrasound of intrinsic wrist ligament and triangular fibrocartilage injuries.
Skeletal Radiol.
2004;
33
85-90
- 10
Hergan K, Mittler C, Oser W.
Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with
US and MRI imaging.
Radiology.
1995;
194
65-71
- 11
Bronstein A J, Koniuch M P, von Holsbeeck M.
Ultrasonographic detection of thumb ulnar collateral ligament injuries: a cadaveric
study.
J Hand Surg [Am].
1994;
19
304-312
- 12
Noszian I M, Dinkhauser L M, Orthner E, Straub G M, Csanady M.
Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with
US.
Radiology.
1995;
194
61-63
- 13
Hergan K, Mittler C.
Sonography of the injured ulnar collateral ligament of the thumb.
J Bone Joint Surg Br.
1995;
77
77-83
- 14
O'Callaghan B I, Kohut G, Hoogewoud H M.
Gamekeeper's thumb: identification of the Stener lesion with US.
Radiology.
1994;
192
477-480
- 15
Ebrahim F S, De Maeseneer M, Jager T, Marcelis S, Jamadar D A, Jacobson J A.
US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based
approach, and differential diagnosis.
Radiographics.
2006;
26
1007-1020
- 16
Schnur D P, DeLone F X, McClellan R M, Bonavita J, Witham R S.
Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries
of the thumb.
Ann Plast Surg.
2002;
49
19-22
- 17
Stener B.
Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal
joint: an underreported but important injury.
J Bone Joint Surg [Br].
1962;
44-B
869-879
- 18
Gaston R G, Lourie G M, Peljovic A.
Radial collateral ligament injury of the index metacarpophalangeal joint: an underreported
but important injury.
J Hand Surg [Am].
2006;
31
1355-1361
- 19
Lopez-Ben R, Lee D H, Nicolodi D J.
Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis
with dynamic US-report of three cases.
Radiology.
2003;
228
642-646
- 20
Serafini G, Derchi L E, Quadri P et al..
High resolution sonography of the flexor tendons in trigger fingers.
J Ultrasound Med.
1996;
15
213-219
- 21
Klauser A, Frauscher F, Bodner G et al..
Finger pulley injuries in extreme rock climbers: depiction with dynamic US.
Radiology.
2002;
222
755-761
- 22
Martinoli C, Bianchi S, Nebiolo M, Derchi L E, Garcia J F.
Sonographic evaluation of digital annular pulley tears.
Skeletal Radiol.
2000;
29
387-391
- 23
Boutry N, Titecat M, Demondion X, Glaude E, Fontaine C, Cotten A.
High-frequency ultrasonographic examination of the finger pulley system.
J Ultrasound Med.
2005;
24
1333-1339
- 24
Taute B M, Behrmann C, Cappeller W A, Podhaisky H.
Ultrasound image of the hypothenar hammer syndrome.
Ultraschall Med.
1998;
19
220-224
- 25
Hauger O, Bonnefoy O, Moinard M, Bersani D, Diard F.
Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution
sonography.
AJR Am J Roentgenol.
2002;
178
1239-1245
- 26
Fusetti C, Poletti P A, Pradel P H et al..
Diagnosis of occult scaphoid fracture with high spatial resolution sonography: a prospective
blind study.
J Trauma.
2005;
59
677-681
- 27
Herneth A M, Siegmeth A, Bader T R et al..
Scaphoid fractures: evaluation with high spatial resolution US: initial results.
Radiology.
2001;
220
231-235
- 28
Blankstein A, Cohen I, Heiman Z, Salai M, Heim M, Chechick A.
Localization, detection and guided removal of soft tissue in the hands using sonography.
Arch Orthop Trauma Surg.
2000;
120
514-517
- 29
Banerjee B, Das R K.
Sonographic detection of foreign bodies of the extremities.
Br J Radiol.
1991;
64
107-112
- 30
Russell R C, Williamson D A, Sullivan J W, Suchy H, Suliman O.
Detection of foreign bodies in the hand.
J Hand Surg [Am].
1991;
16
2-11
- 31
Bajaj S, Lopez-Ben R, Oster R, Alarcon G S.
Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis:
a prospective longitudinal study.
Skeletal Radiol.
2007;
36
123-128
- 32
Varsamidis K, Varsamidou E, Tjetjis V, Mavropoulos G.
Doppler sonography in assessing disease activity in rheumatoid arthritis.
Ultrasound Med Biol.
2005;
31
739-743
- 33
Taouli B, Guermazi A, Sack K E, Genant H K.
Imaging of the hand and wrist in RA.
Ann Rheum Dis.
2002;
61
867-869
- 34
Hau M, Kneitz C, Tony H P, Keberle M, Jahns R, Jenett M.
High resolution ultrasound detects a decrease in pannus vascularisation of small finger
joints in patients with rheumatoid arthritis receiving treatment with soluble tumor
necrosis factor a receptor (etanercept).
Ann Rheum Dis.
2002;
61
55-58
- 35
Ribbens C, Andre B, Marcelis S et al..
Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following
anti-tumor necrosis factor-alpha treatment: pilot study.
Radiology.
2003;
229
562-569
- 36
Koski J M, Hermunen H.
Intra-articular glucocorticoid treatment of the rheumatoid wrist. An ultrasonographic
study.
Scand J Rheumatol.
2001;
30
268-270
- 37
Wakefield R J, Conaghan P G, Jarrett S, Emery P.
Noninvasive techniques for assessing skeletal changes in inflammatory arthritis: imaging
technique.
Curr Opin Rheumatol.
2004;
16
435-442
- 38
Hoving J L, Buchbinder R, Hall S et al..
A comparison of magnetic resonance imaging, sonography, and radiography of the hand
in patients with early rheumatoid arthritis.
J Rheumatol.
2004;
31
663-675
- 39
Wakefield R J, Balint P V, Szkudlarek M.
Musculoskeletal ultrasound including definitions for ultrasonographic pathology.
J Rheumatol.
2005;
32
2485-2487
- 40
Wakefield R J, Gibbon W W, Conaghan P G.
The value of sonography in the detection of bone erosions in patients with rheumatoid
arthritis: a comparison with conventional radiography.
Arthritis Rheum.
2000;
43
2762-2770
- 41
Weidekamm C, Koller M, Weber M, Kainberger F.
Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand
and finger joints in rheumatoid arthritis.
Arthritis Rheum.
2003;
48
325-333
- 42
Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O.
Power Doppler assessment of overall disease activity in patients with rheumatoid arthritis.
J Clin Ultrasound.
2006;
34
5-11
- 43
Naredo E, Collado P, Cruz A et al..
Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity
in early rheumatoid arthritis: predictive value in disease activity and radiologic
progression.
Arthritis Rheum.
2007;
57
116-124
- 44
Chau C L, Griffith J F.
Musculoskeletal infections: ultrasound appearances.
Clin Radiol.
2005;
60
149-159
- 45
Giovagnorio F, Andreoli C, De Cicco M L.
Ultrasonographic evaluation of de Quervain disease.
J Ultrasound Med.
1997;
16
685-689
- 46
Mahakkanukrauh P, Mahakkanukrauh C.
Incidence of a septum in the first dorsal compartment and its effects on therapy of
de Quervain's disease.
Clin Anat.
2000;
13
195-198
- 47
Anderson S E, Steinbach L S, De Monaco D, Bonel H M, Hurtienne Y, Voegelin E.
“Baby wrist”: MRI of an overuse syndrome in mothers.
AJR Am J Roentgenol.
2004;
182
719-724
- 48
de Lima J E, Kim H J, Albertotti F, Resnick D.
Intersection syndrome: MR imaging with anatomic comparison of the distal forearm.
Skeletal Radiol.
2004;
33
627-631
- 49
Parellada A J, Gopez A G, Morrison W B et al..
Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy
with characteristic MR imaging features.
Skeletal Radiol.
2007;
36
203-208
- 50
Parellada A J, Morrison W B, Reiter S B.
Flexor carpi radialis tendinopathy: spectrum of imaging findings and association with
triscaphe arthritis.
Skeletal Radiol.
2006;
35
572-578
- 51
Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi L E.
US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs.
Radiographics.
2000;
20
199-217
- 52
Propeck T, Quinn T J, Jacobson J A, Paulino A F, Habra G, Darian V B.
Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation.
AJR Am J Roentgenol.
2000;
175
1721-1725
- 53
Kele H, Verheggen R, Bittermann H J, Reimers C D.
The potential value of ultrasonography in the evaluation of carpal tunnel syndrome.
Neurology.
2003;
61
389-391
- 54
Bianchi S, Montet X, Martinoli C, Bonvin F, Fasel J.
High-resolution sonography of compressive neuropathies of the wrist.
J Clin Ultrasound.
2004;
32
451-461
- 55
Wiesler E R, Chloros G D, Cartwright M S, Smith B P, Rushing J, Walker F O.
The use of diagnostic ultrasound in carpal tunnel syndrome.
J Hand Surg [Am].
2006;
31
726-732
- 56
Mallouhi A, Pülzl P, Trieb T, Piza H, Bodner G.
Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography.
AJR Am J Roentgenol.
2006;
186
1240-1245
- 57
Beekman R, Visser L H.
Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature.
Muscle Nerve.
2003;
27
26-33
- 58
Bayrak I K, Bayrak A O, Tilki H E, Nural M S, Sunter T.
Ultrasonography in carpal tunnel syndrome: comparison with electrophysiological stage
and motor unit number estimate.
Muscle Nerve.
2007;
35
344-348
- 59
Steiner E, Steinbach L S, Schnarkowski P, Tirman P F, Genant H K.
Ganglia and cysts around joints.
Radiol Clin North Am.
1996;
34
395-425
- 60
Nguyen V, Choi J, Davis K W.
Imaging of wrist masses.
Curr Probl Diagn Radiol.
2004;
33
147-160
- 61
Capelastegui A, Astigarraga E, Fernandez-Canton G et al..
Masses and pseudomasses of the hand and wrist: MR findings in 134 cases.
Skeletal Radiol.
1999;
28
498-507
- 62
Cardinal E, Buckwalter K A, Braunstein E M, Mih A D.
Occult dorsal carpal ganglion: comparison of US and MR imaging.
Radiology.
1994;
193
259-262
- 63
Ho P C, Griffiths J, Lo W N, Yen C H, Hung L K.
Current treatment of ganglion of the wrist.
Hand Surg.
2001;
6
49-58
- 64
De Schepper A M, Hogendoorn P C, Bloem J L.
Giant cell tumors of the tendon sheath may present radiologically as intrinsic osseous
lesions.
Eur Radiol.
2007;
17
499-502
- 65
Middleton W D, Patel V, Teefey S A, Boyer M I.
Giant cell tumors of the tendon sheath: analysis of sonographic findings.
AJR Am J Roentgenol.
2004;
183
337-339
- 66
Timins M E.
Muscular anatomic variants of the wrist and hand: findings on MR imaging.
AJR Am J Roentgenol.
1999;
172
1397-1401
- 67
Fornage B D.
Glomus tumors in the fingers: diagnosis with US.
Radiology.
1988;
167
183-185
Carlo MartinoliM.D.
Cattedra di Radiologia “R”-DICMI
Largo Rosanna Benzi 8, I-16132, Università di Genova, Genova, Italy
Email: carlo.martinoli@libero.it