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The wrist and hand consist of a complex network of tendons, ligaments, nerves, and small joints, making neuromusculoskeletal (NMSK) ultrasound an invaluable imaging modality for precise evaluation and guided interventions. This chapter delves into the utilization of high-resolution ultrasound for diagnosing and managing prevalent wrist and hand pathologies, including tendinopathies, ligament injuries, nerve entrapments (such as carpal tunnel syndrome), inflammatory arthropathies, and mechanical disorders like trigger finger. A comprehensive review of the sonographic anatomy of the extensor and flexor tendons is presented, with particular focus on their organization into six extensor compartments, as well as the maneuver of flexor tendons through the carpal tunnel and Guyon’s canal. The chapter discusses flexor pulley system pathology, especially A1 pulley thickening related to trigger finger, alongside dynamic scanning techniques to evaluate stenosing tenosynovitis and identify abnormal tendon movement or impingement. The chapter highlights the diagnosis and severity grading of carpal tunnel syndrome (CTS) using ultrasound, emphasizing the measurement of the median nerve's cross-sectional area (CSA) at the pisiform level. Additional sonographic markers are explored, including the loss of fascicular pattern, restricted nerve mobility, and increased vascularity on Doppler imaging, which are crucial for distinguishing between mild, moderate, and severe CTS. Furthermore, the text outlines scanning protocols and diagnostic criteria for conditions such as tenosynovitis, partial and complete tendon tears, and impingement syndromes. The chapter also reviews important ultrasound-guided interventions, including corticosteroid injections, hydrodissection for nerve entrapments, and regenerative therapies (e.g., PRP injections). By integrating ultrasound imaging into clinical practice, healthcare providers can achieve real-time, dynamic assessments of wrist and hand conditions, ultimately enhancing diagnostic accuracy and treatment effectiveness.

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Wrist and Hand

  • 章节

  • 发表日期：

    2025年

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  • Andrew M. Mendelson,
  • Reza Salman Roghani,
  • Megan McGuire,
  • Jasmine Sidhu,
  • Naffiseh Jafarian,
  • Ghazaleh Ebrahimi

摘要

The wrist and hand consist of a complex network of tendons, ligaments, nerves, and small joints, making neuromusculoskeletal (NMSK) ultrasound an invaluable imaging modality for precise evaluation and guided interventions. This chapter delves into the utilization of high-resolution ultrasound for diagnosing and managing prevalent wrist and hand pathologies, including tendinopathies, ligament injuries, nerve entrapments (such as carpal tunnel syndrome), inflammatory arthropathies, and mechanical disorders like trigger finger. A comprehensive review of the sonographic anatomy of the extensor and flexor tendons is presented, with particular focus on their organization into six extensor compartments, as well as the maneuver of flexor tendons through the carpal tunnel and Guyon’s canal. The chapter discusses flexor pulley system pathology, especially A1 pulley thickening related to trigger finger, alongside dynamic scanning techniques to evaluate stenosing tenosynovitis and identify abnormal tendon movement or impingement. The chapter highlights the diagnosis and severity grading of carpal tunnel syndrome (CTS) using ultrasound, emphasizing the measurement of the median nerve's cross-sectional area (CSA) at the pisiform level. Additional sonographic markers are explored, including the loss of fascicular pattern, restricted nerve mobility, and increased vascularity on Doppler imaging, which are crucial for distinguishing between mild, moderate, and severe CTS. Furthermore, the text outlines scanning protocols and diagnostic criteria for conditions such as tenosynovitis, partial and complete tendon tears, and impingement syndromes. The chapter also reviews important ultrasound-guided interventions, including corticosteroid injections, hydrodissection for nerve entrapments, and regenerative therapies (e.g., PRP injections). By integrating ultrasound imaging into clinical practice, healthcare providers can achieve real-time, dynamic assessments of wrist and hand conditions, ultimately enhancing diagnostic accuracy and treatment effectiveness.