SCANNING

THIS SECTION IS LIKELY TO TAKE

4-5 MINUTES
 Scanning
Positions Of
Wrist
 Abductor pollicis longus(APL) and Extensor Pollicis Brevis (EPB)

Posterior Extensor Carpi Radialis (ECR) longus and Brevis

Wrist into Extensor Pollicis Longus (EPL)

6 Extensor Digitorum (ED)

Compart Extensor Digiti Minimi (EDM)

ments Extensor Carpi Ulnaris (ECU)

Posterior
Wrist Scan
Anterior
Wrist Scan
Anterior
Wrist Scan
WRIST PATHOLOGY
PROTOCOL
THIS SECTION IS LIKELY TO TAKE
2 MINUTES
 Look for:
Affected by:

●
Tendon abnormalities ●
Natural degeneration with age.
●
Ganglia ●
Or injuries:
●
Fluid ●
Forced rotation (stuck drill)
●
Accessory muscles ●
Racquet sports
●
Any asymmetry with the contra lateral side. ●
Direct blow to medial wrist
• ROLE OF ULTRASOUND
• Ultrasound is a valuable diagnostic tool in assessing the following indications in the wrist:
• Muscular, tendinous and ligamentous damage (chronic and acute)

Joint
Bursitis effusion

Vascular Haemato
pathology mas
Soft tissue Classification of
masses such as a mass eg solid,
ganglia, lipomas cystic, mixed

Post surgical Guidance of

 LIMITATIONS

●
Recent surgery or injections may degrade image quality through the presence of air in the tissue.

EQUIPMENT SELECTION

●
Use of a high resolution probe (10-15MHZ) is essential when assessing the superficial structures of the wrist.
●
Careful scanning technique to avoid anisotropy (and possible mis-diagnosis).
●
Beam steering or compounding can help to overcome anisotropy in linear structures such as tendons.
●
Good colour / power / Doppler capabilities when assessing vessels or vascularity of a structure.
●
Be prepared to change frequency output of probe (or probes) to adequately assess both superficial and deeper structures
 ●
Begin your scan at the wrist crease.
SCANNIN ●
Initially, survey each tendon in transverse
from the musculo-tendinous junction to the
G ●
distal insertion.
Then assess in longitudinal also.
TECHNIQU ●
The tendon sheaths approximately extend for
a couple of cm either side of the wrist crease.

E If necessary, you can compare with the

●

contralateral side.
Screening
De Quervain’s tenosynovitis
Proximal intersection syndrome
Distal intersection syndrome
Scapho-lunate ligament
EVIDEN
CE
THIS SECTION IS LIKELY TO TAKE
GLIMPSE
1. Padovano I, Costantino F, Breban M, D'agostino MA. Prevalence of ultrasound synovial inflammatory findings in healthy subjects.
Annals of the rheumatic diseases. 2016;75(10):1819-23.
2. Chiavaras MM, Jacobson JA, Yablon CM, Brigido MK, Girish G. Pitfalls in wrist and hand ultrasound. American Journal of
Roentgenology. 2014;203(3):531-40.
3. Klauser AS, Tagliafico A, Allen GM, Boutry N, Campbell R, Grainger A, et al. Clinical indications for musculoskeletal ultrasound: a
Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. European radiology. 2012;22(5):1140-8.
4. Micu MC, Serra S, Fodor D, Crespo M, Naredo E. Inter-observer reliability of ultrasound detection of tendon abnormalities at the
wrist and ankle in patients with rheumatoid arthritis. Rheumatology. 2011;50(6):1120-4.
5. Smith J, Finnoff JT. Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications. PM&R. 2009;1(2):162-77.
6. Delle Sedie A, Riente L, Scire CA, Iagnocco A, Filippucci E, Meenagh G, et al. Ultrasound imaging for the rheumatologist XXIV.
Sonographic evaluation of wrist and hand joint and tendon involvement in systemic lupus erythematosus. 2009.
7. Bradley M, O'Donnell P. Atlas of musculoskeletal ultrasound anatomy: Cambridge University Press; 2009.
8. Wright S, Bell A. Enhancement of undergraduate rheumatology teaching through the use of musculoskeletal ultrasound.
Rheumatology. 2008;47(10):1564-6.
9. Wang G, Jacobson JA, Feng FY, Girish G, Caoili EM, Brandon C. Sonography of wrist ganglion cysts: variable and noncystic
appearances. Journal of ultrasound in medicine. 2007;26(10):1323-8.
10. Lee JC, Healy JC. Normal sonographic anatomy of the wrist and hand. Radiographics. 2005;25(6):1577-90.
11. Jacobson JA, editor. Musculoskeletal ultrasound and MRI: which do I choose? Seminars in musculoskeletal radiology; 2005:
Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New ….
12. Terslev L, Torp-Pedersen S, Qvistgaard E, Von der Recke P, Bliddal H. Doppler ultrasound findings in healthy wrists and finger joints.
Annals of the rheumatic diseases. 2004;63(6):644-8.
13. Cardinal É, Bureau NJ, Aubin B, Chhem RK. Role of ultrasound in musculoskeletal infections. Radiologic clinics of north America.
2001;39(2):191-201.
ATLAS OF MUSCULOSKELETAL ULTRASOUND ANATOMY
Authorship
Umar, B., Gilani, S. A., Our Practice Patterns
et. Al focus
Nationwide Study
Psychometric
Investigation for Need Analysis
Wrist

●
Responsiveness
●
Diagnostic Guidelines
Take Home
Anatomy Education

Real time scan

Q&A
Cost effective

Fast decision making

Research based

REMARKS
THIS SECTION IS LIKELY TO TAKE
3 MINUTES