Part of the Medical Radiology book series (MEDRAD)


Joint involvement in the hand and wrist is a feature of many forms of arthritis and because multiple joints are included, a view of both hands and wrists can provide important diagnostic information based on the pattern of disease involvement, even before the actual appearances of the changes are considered. Although for the most part this chapter focuses on plain film appearances, advanced imaging modalities, particularly ultrasound (US) and MRI, are increasingly finding applications in the mainstream clinical imaging of hand arthritis and are discussed in the appropriate sections.


Psoriatic Arthritis Inflammatory Arthritis Crystal Deposition Soft Tissue Change CPPD Crystal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adamson TC 3rd, Resnik CS, Guerra J Jr, Vint VC, Weisman MH, Resnick D (1983) Hand and wrist arthropathies of hemochromatosis and calcium pyrophosphate deposition disease: distinct radiographic features. Radiology 147(2):377–381PubMedGoogle Scholar
  2. Arend WP (2001) Physiology of cytokine pathways in rheumatoid arthritis. Arthritis Rheum 45(1):101–106PubMedCrossRefGoogle Scholar
  3. Arlart IP, Maier W, Leupold D, Wolf A (1982) Massive periosteal new bone formation in ulcerative colitis. Radiology 144(3):507–508PubMedGoogle Scholar
  4. Armstrong RD, Gibson T (1982) Scleroderma and erosive polyarthritis: a disease entity? Ann Rheum Dis 41(2):141–146PubMedCrossRefGoogle Scholar
  5. Arnett FC (1987) Seronegative spondylarthropathies. Bull Rheum Dis 37(1):1–12PubMedGoogle Scholar
  6. Baron M, Lee P, Keystone EC (1982) The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis 41(2):147–152PubMedCrossRefGoogle Scholar
  7. Benjamin M, McGonagle D (2001) The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat 199(Pt 5):503–526PubMedCrossRefGoogle Scholar
  8. Bunch TW, O’Duffy JD, McLeod RA (1976) Deforming arthritis of the hands in polymyositis. Arthritis Rheum 19(2):243–248PubMedCrossRefGoogle Scholar
  9. Chen C, Chandnani VP, Kang HS, Resnick D, Sartoris DJ, Haller J (1990) Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease. Radiology 177(2):459–461PubMedGoogle Scholar
  10. Chen CK, Chung CB, Yeh L, Pan HB, Yang CF, Lai PH et al (2000) Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. AJR Am J Roentgenol 175(3):655–659PubMedCrossRefGoogle Scholar
  11. Ciapetti A, Filippucci E, Gutierrez M, Grassi W (2009) Calcium pyrophosphate dihydrate crystal deposition disease: sonographic findings. Clin Rheumatol 28(3):271–276PubMedCrossRefGoogle Scholar
  12. Cobby M, Cushnaghan J, Creamer P, Dieppe P, Watt I (1990) Erosive osteoarthritis: is it a separate disease entity? Clin Radiol 42(4):258–263PubMedCrossRefGoogle Scholar
  13. De Haas WH, De Boer W, Griffioen F, Oosten-Elst P (1974) Rheumatoid arthritis of the robust reaction type. Ann Rheum Dis 33(1):81–85PubMedCrossRefGoogle Scholar
  14. Ehrlich GE (1972a) Inflammatory osteoarthritis. I. The clinical syndrome. J Chronic Dis 25(6):317–328PubMedCrossRefGoogle Scholar
  15. Ehrlich GE (1972b) Inflammatory osteoarthritis. II. The superimposition of rheumatoid arthritis. J Chronic Dis 25(10):635–643PubMedCrossRefGoogle Scholar
  16. El-Khoury GY, Kathol MH, Brandser EA (1996) Seronegative spondyloarthropathies. Radiol Clin N Am 34(2):343–357 xiPubMedGoogle Scholar
  17. el-Noueam KI, Giuliano V, Schweitzer ME, O’Hara BJ (1997) Rheumatoid nodules: MR/pathological correlation. J Comput Assist Tomogr 21(5):796–799PubMedCrossRefGoogle Scholar
  18. Farrant JM, O’Connor PJ, Grainger AJ (2007a) Advanced imaging in rheumatoid arthritis. Part 1: synovitis. Skeletal Radiol 36(4):269–279PubMedCrossRefGoogle Scholar
  19. Farrant JM, Grainger AJ, O’Connor PJ (2007b) Advanced imaging in rheumatoid arthritis: part 2: erosions. Skeletal Radiol 36(5):381–389PubMedCrossRefGoogle Scholar
  20. Felson DT (2004) An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin N Am 42(1):1–9PubMedCrossRefGoogle Scholar
  21. Fishel B, Caspi D, Eventov I, Avrahami E, Yaron M (1987) Multiple osteonecrotic lesions in systemic lupus erythematosus. J Rheumatol 14(3):601–604PubMedGoogle Scholar
  22. Fornage BD (1989) Soft-tissue changes in the hand in rheumatoid arthritis: evaluation with US. Radiology 173(3):735–737PubMedGoogle Scholar
  23. Gandee R, Harrison R, Dee P (1979) Peritendinitis calcaria of flexor carpi ulnaris. Am J Roentgenol 133(6):1139–1141CrossRefGoogle Scholar
  24. Gibbon WW, Wakefield RJ (1999) Ultrasound in inflammatory disease. Radiol Clin N Am 37(4):633–651PubMedCrossRefGoogle Scholar
  25. Grainger AJ, Farrant JM, O’Connor PJ, Tan AL, Tanner S, Emery P et al (2007) MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skeletal Radiol 36(8):737–745PubMedCrossRefGoogle Scholar
  26. Granberry WM, Mangum GL (1980) The hand in the child with juvenile rheumatoid arthritis. J Hand Surg Am 5(2):105–113PubMedGoogle Scholar
  27. Gravallese EM, Kantrowitz FG (1988) Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 83(7):703–709PubMedGoogle Scholar
  28. Green L, Meyers OL, Gordon W, Briggs B (1981) Arthritis in psoriasis. Ann Rheum Dis 40(4):366–369PubMedCrossRefGoogle Scholar
  29. Gregory LU, Jeff SB, Mark-Friedrich BH, Jay S (2008) Ultrasound-guided intra-articular injection of the trapeziometacarpal joint: description of technique. Arch Phys Med Rehabil 89(1):153–156CrossRefGoogle Scholar
  30. Gubler FM, Maas M, Dijkstra PF, de Jongh HR (1990) Cystic rheumatoid arthritis: description of a nonerosive form. Radiology 177(3):829–834PubMedGoogle Scholar
  31. Haavardsholm EA, Boyesen P, Ostergaard M, Schildvold A, Kvien TK (2008) Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression. Ann Rheum Dis 67(6):794–800PubMedCrossRefGoogle Scholar
  32. Hetland ML, Ejbjerg B, Horslev-Petersen K, Jacobsen S, Vestergaard A, Jurik AG et al (2009) MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA). Ann Rheum Dis 68(3):384–390PubMedCrossRefGoogle Scholar
  33. Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O (1995) Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 24(5):351–355PubMedCrossRefGoogle Scholar
  34. Johnson K, Gardner-Medwin J (2002) Childhood arthritis: classification and radiology. Clin Radiol 57(1):47–58PubMedCrossRefGoogle Scholar
  35. Jonsson A, Borg A, Hannesson P, Herrlin K, Jonsson K, Sloth M et al (1994) Film-screen vs. digital radiography in rheumatoid arthritis of the hand. An ROC analysis. Acta Radiol 35(4):311–318PubMedGoogle Scholar
  36. Keen HI, Wakefield RJ, Grainger AJ, Hensor EM, Emery P, Conaghan PG (2008a) An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms. Arthritis Rheum 59(12):1756–1763PubMedCrossRefGoogle Scholar
  37. Keen HI, Wakefield RJ, Grainger AJ, Hensor EM, Emery P, Conaghan PG (2008b) Can ultrasonography improve on radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology. Ann Rheum Dis 67(8):1116–1120PubMedCrossRefGoogle Scholar
  38. Kidd KL, Peter JB (1966) Erosive osteoarthritis. Radiology 86(4):640–647PubMedGoogle Scholar
  39. Krimmer H, Krapohl B, Sauerbier M, Hahn P (1997) Post-traumatic carpal collapse (SLAC- and SNAC-wrist)—stage classification and therapeutic possibilities. Handchir Mikrochir Plast Chir 29(5):228–233PubMedGoogle Scholar
  40. Labowitz R, Schumacher HR Jr (1971) Articular manifestations of systemic lupus erythematosus. Ann Intern Med 74(6):911–921PubMedCrossRefGoogle Scholar
  41. Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 18(4):481–491Google Scholar
  42. Leczinsky CG (1948) The incidence of arthropathy in a 10 year series of psoriasis cases. Acta Derm Venereol 28(5):483–487PubMedGoogle Scholar
  43. Lin WY, Wang SJ, Lan JL (1995) Evaluation of arthritis in Reiter’s disease by bone scintigraphy and radiography. Clin Rheumatol 14(4):441–444PubMedCrossRefGoogle Scholar
  44. Martel W, Champion CK, Thompson GR, Carter TL (1970) A roentgenologically distinctive arthropathy in some patients with the pseudogout syndrome. Am J Roentgenol Radium Ther Nucl Med 109(3):587–605PubMedCrossRefGoogle Scholar
  45. Martel W, Snarr JW, Horn JR (1973) The metacarpophalangeal joints in interphalangeal osteoarthritis. Radiology 108(1):1–7PubMedGoogle Scholar
  46. Martel W, Stuck KJ, Dworin AM, Hylland RG (1980) Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot. AJR Am J Roentgenol 134(1):125–135PubMedCrossRefGoogle Scholar
  47. Martini A, Ravelli A, Viola S, Burgio RG (1987) Systemic lupus erythematosus with Jaccoud’s arthropathy mimicking juvenile rheumatoid arthritis. Arthritis Rheum 30(9):1062–1064PubMedCrossRefGoogle Scholar
  48. Mason RM, Murray RS, Oates JK, Young AC (1959) A comparative radiological study of Reiter’s disease, rheumatoid arthritis and ankylosing spondylitis. J Bone Joint Surg Br 41-B(1):137–148PubMedGoogle Scholar
  49. McGonagle D, Conaghan PG, O’Connor P, Gibbon W, Green M, Wakefield R et al (1999) The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Arthritis Rheum 42(8):1706–1711PubMedCrossRefGoogle Scholar
  50. McGonagle D, Tan AL, Grainger AJ, Benjamin M (2008) Heberden’s nodes and what Heberden could not see: the pivotal role of ligaments in the pathogenesis of early nodal osteoarthritis and beyond. Rheumatology (Oxford) 47(9):1278–1285CrossRefGoogle Scholar
  51. McGonagle D, Benjamin M, Tan AL (2009) The pathogenesis of psoriatic arthritis and associated nail disease: not autoimmune after all? Curr Opin Rheumatol 21(4):340–347PubMedCrossRefGoogle Scholar
  52. McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL et al (1999) Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 58(3):156–163PubMedCrossRefGoogle Scholar
  53. McQueen FM, Benton N, Perry D, Crabbe J, Robinson E, Yeoman S et al (2003) Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 48(7):1814–1827PubMedCrossRefGoogle Scholar
  54. Miller JL, Soltani K, Tourtellotte CD (1971) Psoriatic acro-osteolysis without arthritis. A case study. J Bone Joint Surg Am 53(2):371–374PubMedGoogle Scholar
  55. Mills PR, Vallance R, Birnie G, Quigley EM, Main AN, Morgan RJ et al (1981) A prospective survey of radiological bone and joint changes in primary biliary cirrhosis. Clin Radiol 32(3):297–302PubMedCrossRefGoogle Scholar
  56. Monu JU, Pope TL Jr (2004) Gout: a clinical and radiologic review. Radiol Clin N Am 42(1):169–184PubMedCrossRefGoogle Scholar
  57. Moore JR, Weiland AJ (1985) Gouty tenosynovitis in the hand. J Hand Surg Am 10(2):291–295PubMedGoogle Scholar
  58. Nalbant S, Corominas H, Hsu B, Chen LX, Schumacher HR, Kitumnuaypong T (2003) Ultrasonography for assessment of subcutaneous nodules. J Rheumatol 30(6):1191–1195PubMedGoogle Scholar
  59. North ER, Eaton RG (1983) Degenerative joint disease of the trapezium: a comparative radiographic and anatomic study. J Hand Surg Am 8(2):160–166PubMedGoogle Scholar
  60. North ER, Rutledge WM (1983) The trapezium-thumb metacarpal joint: the relationship of joint shape and degenerative joint disease. Hand 15(2):201–206PubMedCrossRefGoogle Scholar
  61. Ogilvie C, Kay NR (1988) Fulminating carpal tunnel syndrome due to gout. J Hand Surg Br 13(1):42–43PubMedCrossRefGoogle Scholar
  62. Olivieri I, Barozzi L, Favaro L, Pierro A, de Matteis M, Borghi C et al (1996) Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum 39(9):1524–1528PubMedCrossRefGoogle Scholar
  63. Ostergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B et al (2003) OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30(6):1385–1386PubMedGoogle Scholar
  64. Paskins Z, Rai A (2006) The impact of picture archiving and communication systems (PACS) implementation in rheumatology. Rheumatology (Oxford) 45(3):354–355CrossRefGoogle Scholar
  65. Peter JB, Pearson CM, Marmor L (1966) Erosive osteoarthritis of the hands. Arthritis Rheum 9(3):365–388PubMedCrossRefGoogle Scholar
  66. Peterfy CG (2001) Magnetic resonance imaging in rheumatoid arthritis: current status and future directions. J Rheumatol 28(5):1134–1142PubMedGoogle Scholar
  67. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390–392PubMedGoogle Scholar
  68. Ravelli A, Martini A (2007) Juvenile idiopathic arthritis. Lancet 369(9563):767–778PubMedCrossRefGoogle Scholar
  69. Resnick D (1974) Patterns of peripheral joint disease in ankylosing spondylitis. Radiology 110(3):523–532PubMedGoogle Scholar
  70. Resnick D (1976) Inter-relationship between radiocarpal and metacarpophalangeal joint deformities in rheumatoid arthritis. J Can Assoc Radiol 27(1):29–36PubMedGoogle Scholar
  71. Resnick D (2002a) Chapter 22: Juvenile chronic arthritis. In: Resnick D (ed) Diagnosis of bone and joint disorders. W.B. Saunders Co, Philadelphia, PA, pp 988–1022Google Scholar
  72. Resnick D (2002b) Chapter 39: calcium pyrophosphate dihydrate crystal deposition disease. In: Resnick D (ed) Diagnosis of bone and joint disorders. W.B. Saunders Co, Philadelphia, PA, pp 1560–1618Google Scholar
  73. Resnick D (2002c) Chapter 28: Systemic lupus erthematosus. In: Resnick D (ed) Diagnosis of bone and joint disorders. W.B. Saunders Co, Philadelphia, PA, pp 1171–1193Google Scholar
  74. Resnick D, Greenway G, Vint VC, Robinson CA, Piper S (1978) Selective involvement of the first carpometacarpal joint in scleroderma. AJR Am J Roentgenol 131(2):283–286PubMedCrossRefGoogle Scholar
  75. Savnik A, Malmskov H, Thomsen HS, Graff LB, Nielsen H, Danneskiold-Samsoe B et al (2001) Magnetic resonance imaging of the wrist and finger joints in patients with inflammatory joint diseases. J Rheumatol 28(10):2193–2200PubMedGoogle Scholar
  76. Savnik A, Malmskov H, Thomsen HS, Graff LB, Nielsen H, Danneskiold-Samsoe B et al (2002) MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 12(5):1203–1210PubMedCrossRefGoogle Scholar
  77. Scarpa R, Oriente P, Pucino A, Torella M, Vignone L, Riccio A et al (1984) Psoriatic arthritis in psoriatic patients. Br J Rheumatol 23(4):246–250PubMedCrossRefGoogle Scholar
  78. Sharp JT (1996) Scoring radiographic abnormalities in rheumatoid arthritis. Radiol Clin N Am 34(2):233–241, xPubMedGoogle Scholar
  79. Sicre G, Laulan J, Rouleau B (1997) Scaphotrapeziotrapezoid osteoarthritis after scaphotrapezial ligament injury. J Hand Surg Br 22(2):189–190PubMedCrossRefGoogle Scholar
  80. Stadalnik RC, Dublin AB (1975) Sesamoid periostitis in the thumb in Reiter’s syndrome. Case report. J Bone Joint Surg Am 57(2):279PubMedGoogle Scholar
  81. Steinbach LS (2004) Calcium pyrophosphate dihydrate and calcium hydroxyapatite crystal deposition diseases: imaging perspectives. Radiol Clin N Am 42(1):185–205 viiPubMedCrossRefGoogle Scholar
  82. Steinbach LS, Resnick D (1996) Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology 200(1):1–9PubMedGoogle Scholar
  83. Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P et al (2005) High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 52(8):2355–2365PubMedCrossRefGoogle Scholar
  84. Tan AL, Grainger AJ, Tanner SF, Emery P, McGonagle D (2006a) A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum 54(4):1328–1333PubMedCrossRefGoogle Scholar
  85. Tan AL, Toumi H, Benjamin M, Grainger AJ, Tanner SF, Emery P et al (2006b) Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis 65(10):1267–1272PubMedCrossRefGoogle Scholar
  86. Thiele RG, Schlesinger N (2007) Diagnosis of gout by ultrasound. Rheumatology (Oxford) 46(7):1116–1121CrossRefGoogle Scholar
  87. Uri DS, Dalinka MK (1996) Imaging of arthropathies. Crystal disease. Radiol Clin N Am 34(2):359–374 xiPubMedGoogle Scholar
  88. Utsinger PD, Resnick D, Shapiro RF, Wiesner KB (1978) Roentgenologic, immunologic, and therapeutic study of erosive (inflammatory) osteoarthritis. Arch Intern Med 138(5):693–697PubMedCrossRefGoogle Scholar
  89. van der Jagt EJ, Hofman S, Kraft BM, van Leeuwen MA (2000) Can we see enough? A comparative study of film-screen vs digital radiographs in small lesions in rheumatoid arthritis. Eur Radiol 10(2):304–307PubMedCrossRefGoogle Scholar
  90. Villeneuve E, Emery P (2009) Rheumatoid arthritis: what has changed? Skeletal Radiol 38(2):109–112PubMedCrossRefGoogle Scholar
  91. Vinje O, Dale K, Moller P (1985) Radiographic evaluation of patients with Bechterew’s syndrome (ankylosing spondylitis). Findings in peripheral joints, tendon insertions and the pubic symphysis and relations to non-radiographic findings. Scand J Rheumatol 14(3):279–288PubMedCrossRefGoogle Scholar
  92. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32(12):2485–2487PubMedGoogle Scholar
  93. Watson HK, Ballet FL (1984) The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 9(3):358–365PubMedGoogle Scholar
  94. Watt I, Middlemiss H (1975) The radiology of gout. Review article. Clin Radiol 26(1):27–36PubMedCrossRefGoogle Scholar
  95. Weissman BN, Rappoport AS, Sosman JL, Schur PH (1978) Radiographic findings in the hands in patients with systemic lupus erythematosus. Radiology 126(2):313–317PubMedGoogle Scholar
  96. Whitehouse RW, Aslam R, Bukhari M, Groves C, Cassar-Pullicino V (2005) The sesamoid index in psoriatic arthropathy. Skeletal Radiol 34(4):217–220PubMedCrossRefGoogle Scholar
  97. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM (2009) Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 61(2):233–239PubMedCrossRefGoogle Scholar
  98. Yang BY, Sartoris DJ, Djukic S, Resnick D, Clopton P (1995) Distribution of calcification in the triangular fibrocartilage region in 181 patients with calcium pyrophosphate dihydrate crystal deposition disease. Radiology 196(2):547–550PubMedGoogle Scholar
  99. Yu JS, Chung C, Recht M, Dailiana T, Jurdi R (1997) MR imaging of tophaceous gout. AJR Am J Roentgenol 168(2):523–527PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Musculoskeletal RadiologyChapel Allerton Orthopaedic CentreLeedsUK

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