hand and wrist sonography -...

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US of the Hand and Wrist

Andrej Lyshchik, M.D., Ph.D

Department of Radiology

Thomas Jefferson University Hospital

Outline

• Basic anatomy

• Tendinosis

• Inflammatory disorders

• Trauma

• Nerve entrapment

• Masses

Dorsal Wrist First Extensor Compartment

DeQuervain’s Tenosynovitis DeQuervain’s Tenosynovitis

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DeQuervain’s Tenosynovitis 4th Extensor Compartment

Tenosynovitis

Intersection syndromes

EPL

Proximal intersection syndrome

Distal intersection syndrome Distal intersection syndrome

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Trigger Finger Pulley anatomy

Trigger Finger

A1

nemsi.uchc.edu

A1 pulley

Trigger Finger Trigger Finger

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Trigger Finger Trauma

• Tendon rupture

• Gamekeeper thumb

• Fracture

• Pulley injury

• Ligament tear

Normal flexor tendons FDP rupture

Gamekeeper thumb Gamekeeper thumb

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Steiner lesion

adductor

policis

aponeurosis

UCL

adductor policis

aponeurosis

UCL

Pulley rupture

Normal A2 Pulley A2 Pulley injury

Ulnar Styloid Fracture Normal Dorsal Scapholunate Ligament

L S

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Dorsal Scapholunate Ligament Tear

S L

with stress

Triangular Fibrocartilage Complex

RadioGraphics, http://pubs.rsna.org/doi/abs/10.1148/rg.311105114

Peripheral TFCC Tear Entrapment neuropathy

• Carpal tunnel

• Guyon tunnel

Carpal Tunnel

Carpal Tunnel Syndrome

Criteria

• Cross-sectional area of median nerve at distal

wrist crease

– Up to 0.09 sq cm is normal

– Greater than 0.12 sq cm is abnormal

– 0.09 to 0.12 sq cm: “gray zone”

• Other signs

– Thickening of flexor retinaculum

– Flattening of median nerve within tunnel

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Carpal Tunnel Syndrome

Study

• 100 wrists in 68 patients

• Clinical/ EMG gold standard

• Measure median nerve at proximal third of

pronator quadratus (CSAP)

• Measure median nerve at carpal tunnel (CSAC)

• CSAC minus CSAP > 0.02 sq cm

– 99% sensitive

– 100% specific

Klauser AS, et al. Radiology 2008; 250: 171-177

Normal Median Nerve

Measurement

Carpal Tunnel Syndrome Carpal Tunnel Syndrome

Secondary Carpal Tunnel

Syndrome in RA Bifid Median Nerve

with Persistent Median Artery

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Bifid Median Nerve

with Persistent Median Artery

Bifid Median Nerve

with Persistent Median Artery

Volar Wrist Ganglion Finger Ganglion

Finger Ganglion Rheumatoid Nodule on

Extensor Surface of Finger

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RA in Wrist Lifting Radial Artery Giant Cell Tumor of Tendon Sheath

Rheumatoid Nodule Color Doppler Rheumatoid Nodule on

Flexor Surface of Finger

Vascular Malformation Glomus Tumor

Not Seen on MRI

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Retained foreign bodies Hyperemia Around Foreign Body

Abscess Conclusion

• US is useful in a wide variety of

abnormalities in the hand and wrist

– Inflammation

–Trauma

–Entrapment neuropathies

–Masses

–Foreign bodies