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Dorsal Wrist (Radial, Dorsal, Ulnar)

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Manual of Musculoskeletal Ultrasound

Abstract

The dorsal wrist is a common location for complaints of pain, stiffness, and soft tissue swelling. This chapter explores the many complaints and conditions accessible for diagnosis by ultrasound. These include de Quervain’s tenosynovitis, proximal and distal tendon compartment intersection syndromes, ganglion cysts, and radial nerve compression. The sonographer may evaluate for a scapholunate ligament tear in the proper clinical setting. The dorsal wrist offers information about inflammatory arthropathy, including calcium deposits at the triangular fibrocartilage complex, erosion of the ulnar styloid, and tenosynovitis surrounding the extensor carpi ulnaris. The area is relatively complex, with six tendon compartments and multiple bones and joints. We describe the essential anatomy and a logical protocol to sonographically evaluate the pertinent structures. Further, this chapter offers practical tips for injecting conditions such as de Quervain’s tenosynovitis.

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References

  1. Ağır I, Aytekin MN, Küçükdurmaz F, Gökhan S, Cavuş UY. Anatomical localization of lister’s tubercle and its clinical and surgical importance. Open Orthop J. 2014;8:74–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chan WY, Chong LR. Anatomical variants of lister’s tubercle: a new morphological classification based on magnetic resonance imaging. Korean J Radiol. 2017;18(6):957–63.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ramage JL, Varacallo M. Anatomy, shoulder and upper limb, wrist extensor muscles. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2022.

    Google Scholar 

  4. Sokolow C, Saffar P. Anatomy and histology of the scapholunate ligament. Hand Clin. 2001;17(1):77–81.

    Article  CAS  PubMed  Google Scholar 

  5. Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk GR Jr. The traumatized TFCC: an illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex. Curr Probl Diagn Radiol. 2016;45(1):39–50.

    Article  PubMed  Google Scholar 

  6. Choi SJ, Ahn JH, Ryu DS, Kang CH, Jung SM, Park MS, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography. 2015;34(4):275–91.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tagliafico A, Cadoni A, Fisci E, Gennaro S, Molfetta L, Perez MM, et al. Nerves of the hand beyond the carpal tunnel. Semin Musculoskelet Radiol. 2012;16(2):129–36.

    Article  PubMed  Google Scholar 

  8. Rosskopf AB, Martinoli C, Sconfienza LM, Gitto S, Taljanovic MS, Picasso R, et al. Sonography of tendon pathology in the hand and wrist. J Ultrason. 2021;21(87):e306–17.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goel R, Abzug JM. de Quervain’s tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015;10(1):1–5.

    Article  PubMed  Google Scholar 

  10. de Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop (Belle Mead NJ). 1997;26(9):641–4.

    Google Scholar 

  11. De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. J Ultrasound Med. 2009;28(6):779–86.

    Article  PubMed  Google Scholar 

  12. Wu F, Rajpura A, Sandher D. Finkelstein’s test is superior to Eichhoff’s test in the investigation of de Quervain’s disease. J Hand Microsurg. 2018;10(2):116–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Diop AN, Ba-Diop S, Sane JC, Tomolet Alfidja A, Sy MH, Boyer L, et al. [Role of US in the management of de Quervain’s tenosynovitis: review of 22 cases]. J Radiol. 2008;89(9 Pt 1):1081–4.

    Google Scholar 

  14. Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain’s tenosynovitis. Ann Rheum Dis. 2002;61(11):1034–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Draghi F, Bortolotto C. Intersection syndrome: ultrasound imaging. Skelet Radiol. 2014;43(3):283–7.

    Article  Google Scholar 

  16. Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR imaging and US of the wrist tendons. Radiographics. 2016;36(6):1688–700.

    Article  PubMed  Google Scholar 

  17. Kim CH. Anomalous extensor indicis proprius muscle. Arch Plast Surg. 2013;40(1):79–81.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yoo MJ, Chung KT, Kim JP, Kim MJ, Lee KJ. Tendon impingement of the extensor digiti minimi: clinical cases series and cadaveric study. Clin Anat. 2012;25(6):755–61.

    Article  PubMed  Google Scholar 

  19. Rosskopf AB, Taljanovic MS, Sconfienza LM, Gitto S, Martinoli C, Picasso R, et al. Pulley, flexor, and extensor tendon injuries of the hand. Semin Musculoskelet Radiol. 2021;25(2):203–15.

    Article  PubMed  Google Scholar 

  20. Lillegraven S, Bøyesen P, Hammer HB, Østergaard M, Uhlig T, Sesseng S, et al. Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis. Ann Rheum Dis. 2011;70(11):2049–50.

    Article  PubMed  Google Scholar 

  21. Mohr A, Guermazi A, Genant HK. Value of sonography of the scapholunate ligament. Am J Roentgenol. 2003;181(1):275–7.

    Article  Google Scholar 

  22. Bianchi S, Almusa E, Chick G, Bianchi E. Ultrasound in wrist and hand sport injuries. Aspetar Sports Med J. 2013;3:274.

    Google Scholar 

  23. Shah CM, Stern PJ. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis. Curr Rev Musculoskelet Med. 2013;6(1):9–17.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jacobson JA, Oh E, Propeck T, Jebson PJL, Jamadar DA, Hayes CW. Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy. Am J Roentgenol. 2002;179(2):523–7.

    Article  Google Scholar 

  25. Griffith JF, Chan DP, Ho PC, Zhao L, Hung LK, Metreweli C. Sonography of the normal scapholunate ligament and scapholunate joint space. J Clin Ultrasound. 2001;29(4):223–9.

    Article  CAS  PubMed  Google Scholar 

  26. Rodriguez RM, Ernat JJ. Ultrasonography for dorsal-sided wrist pain in a combat environment: technique, pearls, and a case report of dynamic evaluation of the scapholunate ligament. Mil Med. 2020;185(1–2):e306–11.

    PubMed  Google Scholar 

  27. Reckelhoff KE, Clark TB, Kettner NW. The sonographic squeeze test: assessing the reliability of the dorsal scapholunate ligament. J Med Ultrasound. 2013;21(3):138–42.

    Article  Google Scholar 

  28. Kendi AT, Güdemez E. Sonographic evaluation of scapholunate ligament: value of tissue harmonic imaging. J Clin Ultrasound. 2006;34(3):109–12.

    Article  PubMed  Google Scholar 

  29. Taljanovic MS, Sheppard JE, Jones MD, Switlick DN, Hunter TB, Rogers LF. Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk: initial experience and correlation with arthrography and magnetic resonance arthrography. J Ultrasound Med. 2008;27(2):179–91.

    Article  PubMed  Google Scholar 

  30. Frankel VH. The Terry-Thomas sign. Clin Orthop Relat Res. 1978;135:311–2.

    Google Scholar 

  31. Falsetti P, Conticini E, Baldi C, Bardelli M, Al Khayyat SG, D’Alessandro R, et al. Ultrasound evaluation of the scapholunate ligament and scapholunate joint space in patients with wrist complaints in a rheumatologic setting. J Ultrason. 2021;21(85):e105–e11.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cipolletta E, Smerilli G, Mashadi Mirza R, Di Matteo A, Carotti M, Salaffi F, et al. Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament. Joint Bone Spine. 2020;87(6):611–7.

    Article  CAS  PubMed  Google Scholar 

  33. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am. 1981;6(2):153–62.

    Article  CAS  PubMed  Google Scholar 

  34. Wu WT, Chang KV, Mezian K, Naňka O, Yang YC, Hsu YC, et al. Ulnar wrist pain revisited: ultrasound diagnosis and guided injection for triangular fibrocartilage complex injuries. J Clin Med. 2019;8(10):1540.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chen JH Sr, Huang KC, Huang CC, Lai HM, Chou WY, Chen YC Sr. High power Doppler ultrasound score is associated with the risk of triangular fibrocartilage complex (TFCC) tears in severe rheumatoid arthritis. J Investig Med. 2019;67(2):327–30.

    Article  PubMed  Google Scholar 

  36. Bianchi S, Abdelwahab IF, Zwass A, Giacomello P. Ultrasonographic evaluation of wrist ganglia. Skelet Radiol. 1994;23(3):201–3.

    Article  CAS  Google Scholar 

  37. Bianchi S, Della Santa D, Glauser T, Beaulieu JY, van Aaken J. Sonography of masses of the wrist and hand. AJR Am J Roentgenol. 2008;191(6):1767–75.

    Article  PubMed  Google Scholar 

  38. Teh J. Ultrasound of soft tissue masses of the hand. J Ultrason. 2012;12(51):381–401.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zhang A, Falkowski AL, Jacobson JA, Kim SM, Koh SH, Gaetke-Udager K. Sonography of wrist ganglion cysts: which location is most common? J Ultrasound Med. 2019;38(8):2155–60.

    Article  PubMed  Google Scholar 

  40. Teefey SA, Dahiya N, Middleton WD, Gelberman RH, Boyer MI. Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol. 2008;191(3):716–20.

    Article  PubMed  Google Scholar 

  41. De Keyser F, Isaac Z, Curtis MR (2021) Ganglion cysts of the wrist and hand. UpToDate.

    Google Scholar 

  42. Ikiz ZA, Uçerler H. Anatomic characteristics and clinical importance of the superficial branch of the radial nerve. Surg Radiol Anat. 2004;26(6):453–8.

    Article  PubMed  Google Scholar 

  43. Braidwood AS. Superficial radial neuropathy. J Bone Joint Surg Br. 1975;57(3):380–3.

    Article  CAS  PubMed  Google Scholar 

  44. Saba EKA. Superficial radial neuropathy: an unobserved etiology of chronic dorsoradial wrist pain. Egypt Rheumatol Rehabil. 2021;48(1):29.

    Article  Google Scholar 

  45. Lanzetta M, Foucher G. Entrapment of the superficial branch of the radial nerve (Wartenberg’s syndrome). A report of 52 cases. Int Orthop. 1993;17(6):342–5.

    Article  CAS  PubMed  Google Scholar 

  46. Chiavaras MM, Jacobson JA, Yablon CM, Brigido MK, Girish G. Pitfalls in wrist and hand ultrasound. AJR Am J Roentgenol. 2014;203(3):531–40.

    Article  PubMed  Google Scholar 

  47. Ohrndorf S, Halbauer B, Martus P, Reiche B, Backhaus TM, Burmester GR, et al. Detailed joint region analysis of the 7-joint ultrasound score: evaluation of an arthritis patient cohort over one year. Int J Rheumatol. 2013;2013:493848.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Navalho M, Resende C, Rodrigues AM, Ramos F, Gaspar A, Pereira da Silva JA, et al. Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology. 2012;264(3):823–33.

    Article  PubMed  Google Scholar 

  49. Ceponis A, Kissin E. Ultrasound of the hand and wrist. In: Kohler MJ, editor. Musculoskeletal ultrasound in rheumatology review. 2nd ed. Springer; 2021. p. 53–82.

    Chapter  Google Scholar 

  50. Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EM, Freeston JE, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis. 2015;74(5):897–903.

    Article  PubMed  Google Scholar 

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Correspondence to Mark H. Greenberg .

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Greenberg, M.H., Day, A.L., Alradawi, S. (2023). Dorsal Wrist (Radial, Dorsal, Ulnar). In: Manual of Musculoskeletal Ultrasound . Springer, Cham. https://doi.org/10.1007/978-3-031-37416-6_3

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  • DOI: https://doi.org/10.1007/978-3-031-37416-6_3

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