Learning objectives
To became familiar with the normal ultrasound anatomy of hand and wrist,
including the most common anatomy variations.
To recognize the most common pathological changes of hand and wrist,
including trauma,
degeneration,
inflammation,
and most common tumors.
To clarify the significance of the method for correct diagnosis of the common pathology of hand and wrist.
Background
Rapid ultrasound development and increased use of high frequency linear transducers opened a new chapter in diagnosis of hand and wrist pathology.
The main advantages of this technique is it’s wide availability,
low cost of the exam,
possibility of comparison with contralateral side,
dynamic examination of tendons and muscles and very detailed display of superficial tissues,
with high resolution.
Imaging findings OR Procedure Details
Tendons are consisted of parallel fibrils,
and on high-resolution ultrasound appear as hyperechoic,
uniformly thick structures with fibrillar texture.
They have thin hyperechoic synovial sheath,
spreading distally to the fingers in flexor tendons,
but only present at carpal level in extensor tendons.
Normally there is small amount of anechoic fluid within the synovial sheath(Fig.1,
2).
Ligaments,
same as tendons are consisted of collagen type 1 tissue.
They also have hyperechoic fibrillar structure (Fig.3).
Both tendons and ligaments can appear hypo/anechoic,
due to anisotropy artefact,
if...
Conclusion
Sufficient knowledge of the normal ultrasound anatomy and the most common pathological changes,
knowing the advantages but also the limitations of the method compared to other imaging modalities is crucial for quick and accurate diagnosis of the common hand and wrist pathology.
Majority of soft-tissue lesions of the hand and wrist can be adequately examined with high-resolution ultrasound.
They include tenosynovitis and tendon tears,
soft-tissue focal lesions such as tumors and ganglion cysts,
foreign bodies,
as well as pathology of the hand and wrist nerves.
References
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Carpal tunnel syndrome: diagnosis with high-resolution sonography.
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Chiavaras MM,
Jacobson JA,
Yablon CM,
Kalume Brigido M,
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Pitfalls in Wrist and Hand Ultrasound.
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2014.
Lee CH and Tandon A.
Focal hand lesions: review and radiological approach.
Insights Imaging.
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Lee JC,
Healy JC.
Normal sonographic anatomy of the wrist and hand.
Radiographics.
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Middelton WD,
Teefey SA,
Boyer MI.
Hand and wrist sonography.
Ultrasound Quarterly 2001; 17:21-36.
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