Imaging of Wrist DR AMITA HARSULE

Basic Radiograph ROUTINE ■ PA ■ Lateral ■ Scaphoid series – when there is tenderness in the anatomical snuff box.

PA ulnar deviation

note the disruption of arc I at the lunotriquetral joint.

A disruption of the second carpal arc at the scapholunate joint and the lunotriquetral joint is seen on the left.

There is an abnormal step off at the capitohamate joint.

Volar aspect of the wrist

USG

CT

CT

Ligamentous Anatomy Classified as either extrinsic or intrinsic. The extrinsic ligaments link the carpal bones to the radius and ulna. The intrinsic or intercarpal ligaments connect the individual carpal bones.

Normal TFCC. Triangular fibrocartilage proper (*). Foveal (arrow) and styloid (dashed arrow) insertions. Meniscus homologue (arrow head). Normal lunotriquetral (LTL) and scapholunate (SLL) ligaments are also seen.

MENISCUS HOMOLOGUE

Tendon pathology Tendon pathology is often encountered in the wrist and hand, which may be the result of overuse, trauma or inflammation. Patients typically present with focal pain and swelling. The term "tendinitis" is an inaccurate term A better term is tendinosis, which describes a degenerative process with "microtears", healing and vascular in-growth. The term "tendinopathy" encompasses both degenerative and inflammatory conditions. Tenosynovitis refers to inflammatory change within the tendon sheath, with or without tendon morphological changes.

flexor tenosynovitis

Carpal Tunnel $ Causes include flexor tenosynovitis, trauma, systemic inflammatory disease, pregnancy, acromegaby, hypothyroidism

Space-occupying lesions within the carpal tunnel such as ganglia, tenosynovitis, and anatomic variants are well seen with MR imaging MR imaging is therefore indicated only in patients with equivocal clinical findings, a suspected mass

Compressive ulnar neuropathy. At the level of the canal of Guyon’s. The Guyon canal is a triangular space lateral to the pisiform bone and medial to the hamate that contains the ulnar nerve and ulnar artery. The ulnar nerve (arrow) has high signal intensity and it is thickened. There is a ganglion cyst (*) compressing the ulnar nerve against the pisiform.

GANGUON CYSTS Seventy percent of all wrist ganglia occur dorsally adjacent to the SLL

1. ganglion cyst that arises from the dorsal aspect of the SLL 2. volar ganglion cyst adjacent to the radioscaphoid joint

schwannoma of radial nerve

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