Ultrasound of the wrist and hand joints

The ultrasound method (ultrasound) has a number of advantages over magnetic resonance imaging in examining the soft tissues of the wrist and hand joints. Several points can be highlighted that emphasize these advantages. Firstly, it is the convenience of ultrasound and the ability to quickly compare symmetrical sections. Secondly, the high resolution of ultrasound examination, which allows evaluating very fine structures of tendons and ligaments. Thirdly, there is a simple and easy possibility of dynamic examination in real time. Ultrasound examination of the wrist and small joints of the hand should be performed with high-frequency sensors, preferably with a scanning frequency of 10-12-15 MHz.

Anatomy of the wrist and hand

The wrist joint is formed by the articular surface of the radius and the distal surface of the articular disc, represented by the scaphoid, lunate and triquetral bones.

The stability of the joint is ensured by two lateral ligaments of the wrist: the radial ligament, attached to the styloid process of the radius and the scaphoid bone, and the ulnar ligament, which starts from the styloid process of the ulna and attaches to the triquetral bone and partially to the pisiform bone. On the dorsal and palmar sides, the wrist joint is strengthened by the dorsal palmar and radiocarpal ligaments. Flexion, extension, adduction, abduction and rotation are performed in the wrist joint. The interphalangeal joints of the hand are located between the adjacent phalanges of each finger. The ligamentous apparatus of the interphalangeal joints of the hand is represented by the palmar ligaments, which extend from the lateral surfaces of the blocks and are attached: some - to the lateral surface of the phalanges - lateral ligaments, and others - to their palmar surface. The first thumb has one interphalangeal joint. The tendons of the superficial and deep flexors of the fingers pass along the palmar surface of the hand.

Anatomy of the wrist and hand

Ultrasound examination technique

The examination of the wrist and hand joints is carried out strictly according to clinical indications. The patient usually sits opposite the researcher. Depending on the area of interest, the palm or the back of the hand lies on the knees. Longitudinal and transverse sections of the structures of interest are obtained. Performing functional tests helps in assessing the localization of the corresponding groups of tendons. When examining the palmar surface of the wrist joint, the sensor is installed transversely, the flexor tendons, medial nerve, and ulnar nerve are assessed.

Methodology for performing ultrasound examination of the wrist and hand

Ultrasound diagnostics of injuries and diseases of the wrist and hand joints

Tenosynovitis. One of the most common pathologies of this localization. The most common cause of tenosynovitis is rheumatoid arthritis. With the development of tenosynovitis, effusion occurs in the synovial sheath of the tendons. The synovial membrane thickens, the degree of its vascularization increases. With chronic tenosynovitis, the tendon itself is involved in the process, which can contribute to its rupture. With tenosynovitis of small tendons of the hand, detection of effusion is difficult. Indirect signs of its presence are increased echogenicity of the bone phalanx. For clarification, comparison with a symmetrical phalanx is recommended.

Tendon ruptures. Ruptures of the tendons of the wrist and hand joints are relatively rare. Chronic changes in the tendons, rheumatoid arthritis, gouty arthritis, systemic diseases, diabetes mellitus, etc. predispose to ruptures. Rupture of the extensor tendon of the finger from the attachment at the base of the nail phalanx is the most common of the subcutaneous tendon ruptures. It occurs with a sharp bending of the finger at a time when the tendon is actively contracted. Such ruptures are observed in basketball, in pianists, and surgeons. Tendon rupture may be accompanied by the rupture of a triangular fragment from the base of the phalanx. With this type of injury, the finger acquires a characteristic hammer-shaped form.

Ultrasound signs of damage and diseases of the wrist and hand joints