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Ultrasound of the wrist and joints of the hand
Last reviewed: 18.10.2021
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The ultrasonic method (US) has a number of advantages over magnetic resonance imaging in the study of soft tissues of wrist joints and hand joints. There are several points that emphasize these advantages. First, it is the convenience of carrying out ultrasound and the ability to quickly compare the symmetrical departments. Secondly, high resolution in ultrasound, which allows you to assess the very fine structure of tendons and ligaments. Thirdly, there is a simple and uncomplicated possibility of dynamic real-time research. Ultrasound examination of the wrist joint and small joints of the hand should be performed by 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 joint surface of the radial bone and the distal surface of the articular disc, represented by the scaphoid, semilunar and trihedral bones.
Stability of the joint is provided by two lateral ligaments of the wrist: radial, attached to the styloid process of the radial bone and the scaphoid bone, and the ulnar, starting from the styloid process of the ulna and attached to the trihedral bone and partly to the pea. On the back and palmar side, the wrist joint is strengthened due to the dorsal palmar and radiocarpal ligaments. In the radiocarpal joint, flexion, extension, reduction, retraction and rotation are performed. Interphalangeal joints of the hand are located between adjacent phalanges of each finger. The ligamentous apparatus of the interphalangeal joints of the hand is represented by the palmar ligaments that run from the side surfaces of the blocks and are attached: one to the lateral surface of the phalanx - lateral ligaments, and others - to their palmar surface. The first thumb has one interphalangeal joint. On the palmar surface of the hand pass the tendons of the superficial and deep flexors of the fingers.
Method of ultrasound examination
The study of the wrist joint and the hand joints is carried out strictly according to clinical indications. The patient usually sits opposite the researcher. Depending on the zone of interest, the palm or the back surface lie on the knees. The longitudinal and transverse sections of the structures of interest are obtained. The performance of functional samples helps in assessing the localization of the corresponding tendon groups. When examining the palmar surface of the wrist joint, the transducer is installed transversely, the flexor tendons, the medial nerve, and the ulnar nerve are evaluated.
Methods of ultrasound of the wrist and hand
Ultrasonic diagnostics of injuries and diseases of the wrist joint and the joints of the hand
The Tenosynovites. One of the most frequent pathologies of this localization. The most common cause of development of tenosynovitis is rheumatoid arthritis. With the development of tenosynovitis, effusion occurs in the synovial vagina 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, the detection of effusion is difficult. Indirect signs of its presence is an increase in echogenicity of the bone phalanx. For clarification, a comparison with a symmetrical phalanx is recommended.
Tendon ruptures. Tears of the tendon of the wrist joint and the joints of the hand are relatively rare. Tensions are predisposed to chronic changes in tendons, rheumatoid arthritis, gouty arthritis, systemic diseases, diabetes mellitus, etc. Detachment of the extensor tendon of the finger from the attachment site at the base of the nail phalanx is the most frequent of the subcutaneous ruptures of the tendons. It occurs with a sharp bending of the finger at a time when the tendon is actively reduced. Such detachments are observed when playing basketball, pianists, surgeons. The detachment of the tendon can be accompanied by the detachment of a triangular fragment from the base of the phalanx. In this type of injury, the finger acquires a characteristic hammer-shaped shape.
Ultrasound signs of injuries and diseases of the wrist and joints of the hand