Radiologic Imaging of Wrist, Hand, and Finger Injuries

  • Jan L. M. A. GielenEmail author
  • Pieter Van Dyck


Acute and overuse injuries to the wrist and hand occur with a higher frequency in specific sports utilizing the hand and wrist. Wrist lesions may sometimes be difficult to diagnose on physical examination. Proper clinical and radiological diagnosis of injuries in this region requires a thorough knowledge of the anatomy and biomechanics of the wrist. Knowledge of the sports activity aids in the diagnosis of these injuries as sporting activities may be associated with specific injury patterns. Important acute injuries that should not to be missed are any type of carpal dislocation especially lunate and perilunate dislocation. Special considerations are made in preadolescent and adolescent athletes, as hand and wrist injuries are more common in these age groups compared to adults.

Fractures are primarily examined radiographically; complex intra-articular fracture components are evaluated with multiplanar or cone beam CT. Despite the fact that nondisplaced fractures are a radiological challenge and occult fractures are frequent, radiography remains the first imaging modality in the initial evaluation and follow-up. If clinically suspected, additional examinations are mandatory, whether repeated radiographs after 1 week of immobilization, or bone scintigraphy, or MRI. Because of its sensitivity, specificity, absence of radiation exposure, and lower cost, MRI is the imaging modality of choice over nuclear imaging techniques for depiction of radiographic occult fractures. Multislice CT or cone beam CT with its high spatial resolution and multiplanar two-dimensional reconstructions in three orthogonal imaging planes improves visualization and characterization of the fracture line and the amount of displacement and angulation of the fracture fragments or staging. AVN is studied with contrast-enhanced MRI. Stress fractures are lately recognized on radiographs related to endosteal spongious callus with bandlike increased bone density. On MRI they are early and easily demonstrated. On MRI, the presence of edema without a visible fracture line may represent a bone bruise or a stress reaction recognized as forestage of stress fracture.

About 10 % of carpal injuries result in instability. Clinical findings are often nonspecific. Imaging is important as diagnosis of a significant injury will dictate treatment. Wrist instability most commonly results from ligamentous disruption between bones of the proximal carpal row. The presence or absence of carpal instability on radiographs depends on the association between intrinsic and extrinsic ligament tears – even partial ones – rather than on the presence of intrinsic ligament tears alone, even when the tears are complete. An instability pattern in the radiocarpal or midcarpal joint with carpal dissociation is called carpal instability dissociative (CID); carpal instability without carpal dissociation is known as carpal instability nondissociative (CIND).

Imaging evaluation of patients with ulnar-sided wrist pain is mandatory because of its broad clinical differential diagnosis comprising DRUJ, TFCC, LT, and ECU lesions, pisotriquetral instability, ulnoradial impingement, and ulnocarpal impaction-abutment. Radiographs demonstrate the variance of the ulna, distal radioulnar joint dislocations, and signs of chronic ulnar impaction-abutment syndrome related to ulna majus or ulnoradial impingement related to ulna minus. TFCC evaluation is done with MRI.

Overuse tendon injuries are more frequent compared to acute tendon lesions. Inflammation of tendon sheaths is the most frequent abnormality found on US of the wrist. Ultrasound or MRI is only indicated in chronic recidivism. Tendon rupture and its severity can also be detected on US.

Peripheral nerve injuries of the upper extremity in sports are rarely reported; however, they can be most debilitating to an athlete. Peripheral nerves are prone to various types of injury in sport owing to their superficial location. Most commonly, direct blows or repetitive microtrauma is implicated as a mechanism of injury. Hypothenar hammer syndrome (HHS) is related to repetitive trauma of the ulnar-volar aspect of the wrist. Doppler ultrasound along is an accurate noninvasive test to determine the presence, size, and extent of HHS. Bicyclists develop ulnar nerve impingement at Guyon’s canal.


Carpal Tunnel Scaphoid Fracture Adductor Pollicis Ulnar Collateral Ligament Extensor Carpus Radialis 
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.





Avascular necrosis


Carpal instability dissociative


Carpal instability nondissociative


Carpometacarpal joint


Computerized tomography


Computerized tomography combined with arthrography


Distal interphalangeal joint


Distal radioulnar (joint)


Diethylene triamine pentaacetic acid


Extensor carpi radialis (brevis and/or longus)


Extensor pollicis longus


Flexor carpi radialis


Flexor carpi ulnaris


Fall onto the outstretched hand


Fat saturation


Gradient echo


Hypothenar hammer syndrome




Lunotriquetral ligament


Midcarpal instability






Magnetic resonance imaging combined with arthrography


Magnetic resonance imaging


Musculotendinous unit

N Med

Median nerve






Proton density


Posterior interosseous nerve, deep branch of the radial nerve


Proximal interphalangeal joint


Palmaris longus




Radiolunotriquetral ligament (volar)


Range of motion


Radioscapholunate ligament (volar)


Spin echo


Signal intensity


Scapholunate ligament


Scapholunate advanced collapse


Short tau inversion recovery






Triangular fibrocartilage (fibrocartilaginous complex)


Turbo spin echo


Weighted imaging


  1. Ablett CT, Hackett LA (2008) Hypothenar hammer syndrome: case reports and brief review. Clin Med Res 6(1):3–8. doi: 10.3121/cmr.2008.775. ReviewPubMedCentralCrossRefPubMedGoogle Scholar
  2. Aronowitz ER, Leddy JP (1998) Closed tendon injuries of the hand and wrist in athletes. Clin Sports Med 17(3):449–467CrossRefPubMedGoogle Scholar
  3. Bayes MC, Wadsworth LT (2009) Upper extremity injuries in golf. Phys Sportsmed 37(1):92–96CrossRefPubMedGoogle Scholar
  4. Bednar MS, Arnoczky SP, Weiland AJ (1991) The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg Am 16(6):1101–1105CrossRefPubMedGoogle Scholar
  5. Benjamin M, Evans EL, Pemberton DJ (1990) Histological studies on the triangular fibrocartilage complex of the wrist. J Anat 172:59–67PubMedCentralPubMedGoogle Scholar
  6. Bergin D, Schweitzer ME (2003) Indirect magnetic resonance arthrography. Skeletal Radiol 32(10):551–558CrossRefPubMedGoogle Scholar
  7. Brudvik C, Hove LM (2003) Childhood fractures in Bergen, Norway: identifying high-risk groups and activities. J Pediatr Orthop 23(5):629–634CrossRefPubMedGoogle Scholar
  8. Cohen MS (1998) Ligamentous injuries of the wrist in the athlete. Clin Sports Med 17(3):533–552CrossRefPubMedGoogle Scholar
  9. Creteur V, Peetrons PJ (2000) Ultrasonography of the wrist and the hand. J Radiol 81(3 Suppl):346–352. [Article in French]PubMedGoogle Scholar
  10. de Lima JE, Kim HJ, Albertotti F, Resnick D (2004) Intersection syndrome: MR imaging with anatomic comparison of the distal forearm. Skeletal Radiol 33:627–631CrossRefPubMedGoogle Scholar
  11. Dreizin D, Jose J (2012) Hypothenar hammer syndrome. Am J Orthop 41(8):380–382PubMedGoogle Scholar
  12. Futami T, Aoki H, Tsukamoto Y (1993) Fractures of the hook of the hamate in athletes. 8 cases followed for 6 years. Acta Orthop Scand 64(4):469–471CrossRefPubMedGoogle Scholar
  13. Gabl M, Lener M, Pechlaner S, Judmaier W (1996) The role of dynamic magnetic resonance imaging in the detection of lesions of the ulnocarpal complex. J Hand Surg Br 21(3):311–314CrossRefPubMedGoogle Scholar
  14. Geissler WB (2001) Carpal fractures in athletes. Clin Sports Med 20(1):167–188CrossRefPubMedGoogle Scholar
  15. Guerini H, Drapé JL, Le Viet D, Thevenin F, Roulot E, Pessis E, Montalvan B, Feydy A, Chevrot A (2007) Imaging of wrist injuries in athletes. J Radiol 88(1 Pt 2):111–128. [Article in French]CrossRefPubMedGoogle Scholar
  16. Halikis MN, Taleisnik J (1996) Soft-tissue injuries of the wrist. J Clin Sports Med 15(2):235–259Google Scholar
  17. Hanks GA, Kalenak A, Bowman LS, Sebastianelli WJ (1989) Stress fractures of the carpal scaphoid. A report of four cases. J Bone Joint Surg Am 71(6):938–941PubMedGoogle Scholar
  18. Hassan I, Dorani BJ (2001) Sports related fractures in children in north east England. Emerg Med J 18(3):167–171PubMedCentralCrossRefPubMedGoogle Scholar
  19. Howse C (1994) Wrist injuries in sport. Sports Med 17(3):163–175CrossRefPubMedGoogle Scholar
  20. Kulthanan T, Chareonwat B (2007) Variations in abductor pollicis longus and extensor pollicis brevis tendons in de Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg 41:36–38CrossRefPubMedGoogle Scholar
  21. Lichtman DM, Schneider JR, Swafford AR (1981) Ulnar midcarpal instability. Clinical and laboratory analysis. J Hand Surg Am 6:515–523CrossRefPubMedGoogle Scholar
  22. Linscheid RL, Dobyns JH, Beabout JW, Bryan RS (1972) Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 54(8):1612–1632PubMedGoogle Scholar
  23. Lohman M, Vasenius J, Kivisaari A, Kivisaari L (2001) MR imaging in chronic rupture of the ulnar collateral ligament of the thumb. Acta Radiol 42(1):10–14CrossRefPubMedGoogle Scholar
  24. Lyons RA, Delahunty AM, Kraus D, Heaven M, McCabe M, Allen H, Nash P (1999) Children’s fractures: a population based study. Inj Prev 5(2):129–132PubMedCentralCrossRefPubMedGoogle Scholar
  25. Maizlin ZV, Brown JA, Clement JJ, Grebenyuk J, Fenton DM, Smith DE, Jacobson JA (2009) MR arthrography of the wrist: controversies and concepts. Hand (N Y) 4(1):66–73. Epub 2008 Dec 2CrossRefGoogle Scholar
  26. Mardel S, Underwood M (1991) Adductor pollicis. The missing interosseous. Surg Radiol Anat 13:1CrossRefGoogle Scholar
  27. McCue FC 3rd, Baugher WH, Kulund DN, Gieck JH (1979) Hand and wrist injuries in the athlete. Am J Sports Med 7(5):275–286CrossRefPubMedGoogle Scholar
  28. Noël B, Hayoz D (2000) A tennis player with hand claudication. Vasa 29(2):151–153CrossRefPubMedGoogle Scholar
  29. Nuber GW, Assenmacher J, Bowen MK (1998) Neurovascular problems in the forearm, wrist and hand. Clin Sports Med 17(3):585–610CrossRefPubMedGoogle Scholar
  30. Ogden JA (1982) Skeletal growth mechanism injury patterns. J Pediatr Orthop 2(4):371–377. doi: 10.1097/01241398-198210000-00004 CrossRefPubMedGoogle Scholar
  31. Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14(4):594–606. ReviewCrossRefPubMedGoogle Scholar
  32. Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist – anatomy and function. J Hand Surg Am 6(2):153–162CrossRefPubMedGoogle Scholar
  33. Parellada AJ, Gopez AG, Morrison WB, Sweet S, Leinberry CF, Reiter SB, Kohn M (2007) Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features. Skeletal Radiol 36(3):203–208CrossRefPubMedGoogle Scholar
  34. Pitner MA (1990) Pathophysiology of overuse injuries in the hand and wrist. Hand Clin 6(3):355–64. ReviewGoogle Scholar
  35. Propeck T, Quinn TJ, Jacobson JA, Paulino AF, Habra G, Darian VB (2000) Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation. AJR Am J Roentgenol 175(6):1721–1725CrossRefPubMedGoogle Scholar
  36. Rang M (ed) (1968) The growth plate and its disorders. Harcourt Brace/Churchill Livingstone, Edinburgh, London. ISBN 978-0-443-00568-8Google Scholar
  37. Rettig AC (1998) Elbow, forearm and wrist injuries in the athlete. Sports Med 25(2):115–30. ReviewGoogle Scholar
  38. Rettig AC (2001) Wrist and hand overuse syndromes. Clin Sports Med 20(3):591–611CrossRefPubMedGoogle Scholar
  39. Salter RB, Harris WR (1963) Injuries involving the epiphyseal plate. J Bone Joint Surg Am 45:587–622Google Scholar
  40. Taljanovic MS, Karantanas A, Griffith JF, DeSilva GL, Rieke JD, Sheppard JE (2012) Imaging and treatment of scaphoid fractures and their complications. Semin Musculoskelet Radiol 16(2):159–173CrossRefPubMedGoogle Scholar
  41. Taylor BL, Attia MW (2000) Sports-related injuries in children. Acad Emerg Med 7(12):1376–82CrossRefPubMedGoogle Scholar
  42. Theumann NH, Etechami G, Duvoisin B, Wintermark M, Schnyder P, Favarger N, Gilula A (2006) Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations. Radiology 238(3):950–957. Epub 2006 Jan 19CrossRefPubMedGoogle Scholar
  43. Toms A, Chojnowski A (2009) Midcarpal instability: a diagnostic role for dynamic ultrasound? Cahir J Ultraschall Med 30(3):286–290. Epub 2009 Jun 2CrossRefPubMedGoogle Scholar
  44. Totterman SM, Miller RJ (1995) Triangular fibrocartilage complex: normal appearance on coronal three-dimensional gradient-recalled-echo MR images. Radiology 195(2):521–527CrossRefPubMedGoogle Scholar
  45. Troupis JM, Amis B (2013) Four-dimensional computed tomography and trigger lunate syndrome. J Comput Assist Tomogr 37(4):639–643CrossRefPubMedGoogle Scholar
  46. Viegas SF, Patterson RM, Peterson PD, Pogue DJ, Jenkins DK, Sweo TD, Hokanson JA (1990) Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg Am 15(2):268–278CrossRefPubMedGoogle Scholar
  47. Weiss LE, Taras JS, Sweet S, Osterman AL (2000) Lunotriquetral injuries in the athlete. Hand Clin 16(3):433–438PubMedGoogle Scholar
  48. Zayed MA, McDonald J, Tittley JG (2013) Hypothenar hammer syndrome from ice hockey stick-handling. Ann Vasc Surg 27(8):1183.e5–1183.e10. Epub 2013 Aug 26CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of RadiologyAntwerp University HospitalEdegemBelgium
  2. 2.Department of Sports MedicineAntwerp University HospitalEdegemBelgium
  3. 3.Department of MedicineAntwerp UniversityEdegemBelgium
  4. 4.Department of RadiologyAntwerp University HospitalAntwerpBelgium

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