Download PDF
Semin Musculoskelet Radiol 2007; 11(2): 95-104
DOI: 10.1055/s-2007-1001875
© Thieme Medical Publishers

Wrist and Hand Ultrasound

Alberto Tagliafico1 , Maurizio Rubino2 , Alberto Autuori3 , Stefano Bianchi4 , Carlo Martinoli1
  • 1Cattedra di Radiologia “R”-DICMI, Università di Genova, Genova, Italy
  • 2I Divisione di Ortopedia, Ospedale San Martino, Genova, Italy
  • 3Clinica Ortopedica Universitaria, Ospedale San Martino, Università di Genova, Genova, Italy
  • 4Clinique et Fondation des Grangettes, Chene-Bougeries, Switzerland
Further Information

Publication History

Publication Date:
20 December 2007 (online)

Also available at
   Permissions and Reprints

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
    CrossrefPubMedSearch in Google Scholar
  • 2 Teefey S A, Middleton W D, Boyer M I. Sonography of the hand and wrist.  Semin Ultrasound CT MR. 2000;  21 192-204
    CrossrefPubMedSearch in Google Scholar
  • 3 Middleton W D, Teefey S A, Boyer M I. Hand and wrist sonography.  Ultrasound Q. 2001;  17 21-36
    CrossrefPubMedSearch in Google Scholar
  • 4 Lee D. Sonography of the wrist and hand.  Semin Musculoskelet Radiol. 1998;  2 237-244
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Finlay K, Lee R, Friedman L. Ultrasound of intrinsic wrist ligament and triangular fibrocartilage injuries.  Skeletal Radiol. 2004;  33 85-90
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 13 Hergan K, Mittler C. Sonography of the injured ulnar collateral ligament of the thumb.  J Bone Joint Surg Br. 1995;  77 77-83
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 24 Taute B M, Behrmann C, Cappeller W A, Podhaisky H. Ultrasound image of the hypothenar hammer syndrome.  Ultraschall Med. 1998;  19 220-224
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 29 Banerjee B, Das R K. Sonographic detection of foreign bodies of the extremities.  Br J Radiol. 1991;  64 107-112
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 36 Koski J M, Hermunen H. Intra-articular glucocorticoid treatment of the rheumatoid wrist. An ultrasonographic study.  Scand J Rheumatol. 2001;  30 268-270
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 39 Wakefield R J, Balint P V, Szkudlarek M. Musculoskeletal ultrasound including definitions for ultrasonographic pathology.  J Rheumatol. 2005;  32 2485-2487
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 44 Chau C L, Griffith J F. Musculoskeletal infections: ultrasound appearances.  Clin Radiol. 2005;  60 149-159
    CrossrefPubMedSearch in Google Scholar
  • 45 Giovagnorio F, Andreoli C, De Cicco M L. Ultrasonographic evaluation of de Quervain disease.  J Ultrasound Med. 1997;  16 685-689
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 60 Nguyen V, Choi J, Davis K W. Imaging of wrist masses.  Curr Probl Diagn Radiol. 2004;  33 147-160
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 66 Timins M E. Muscular anatomic variants of the wrist and hand: findings on MR imaging.  AJR Am J Roentgenol. 1999;  172 1397-1401
    PubMedSearch in Google Scholar
  • 67 Fornage B D. Glomus tumors in the fingers: diagnosis with US.  Radiology. 1988;  167 183-185
    PubMedSearch in Google Scholar

Carlo MartinoliM.D. 

Cattedra di Radiologia “R”-DICMI

Largo Rosanna Benzi 8, I-16132, Università di Genova, Genova, Italy

Email: carlo.martinoli@libero.it