2/21/2018 1 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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2/21/2018
1
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
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