IMAGING OF THE HAND AND WRIST

https://doi.org/10.1016/S0030-5898(05)70308-4Get rights and content

Section snippets

RADIOGRAPHY

All diagnostic imaging of the hand or wrist should begin with radiographs or plain films. However, a common mistake is to request the wrong or insufficient views. It is one of the basic concepts of radiology that at least two projections are required to evaluate any structure. Figure 1 is an example of why this is important. The authors' standard series of the hand or finger includes three views: postero–anterior (PA), oblique, and lateral. For the wrist, PA, PA ulnar deviation, oblique, and

STANDARD MEASUREMENTS

Given a well–positioned PA and lateral view of the wrist as described previously, it is possible to make many standard measurements of carpal height and alignment. These are described in detail in a review article by Mann and colleagues24 as well as in the textbook by Gilula and Yin.4 For many of these measurements, various clinicians advocate different methods of drawing the necessary lines. The following section details a few of the measurement schemes that the authors have found useful. The

CARPAL INSTABILITY

Numerous patterns of carpal instability have been described, and various schemes exist for classifying them. Carpal instabilities can be either static or dynamic. Static instabilities are manifest by abnormal alignment on PA and lateral radiographs obtained in neutral orientations, whereas dynamic instabilities can appear normal on neutral films and may require stress radiographs or provocative maneuvers to be revealed. The key to identifying carpal malalignment is to examine the position of

ADVANCED IMAGING MODALITIES

Planar radiographs coupled with physical examination are usually sufficient for the work–up of a painful hand or wrist. However, when these techniques fail to elucidate the cause of the symptoms, further imaging studies may be required. The following sections present representative cases illustrating the utility of these modalities. Readers seeking a more thorough discussion are referred to the specific modality chapters in the text by Gilula and Yin, as well as to a good review article on

First page preview

First page preview
Click to open first page preview

References (43)

  • P. Vo et al.

    Evaluating dorsal wrist pain: MRI diagnosis of occult dorsal wrist ganglion

    J Hand Surg

    (1995)
  • H. Abbaszadegan et al.

    Prediction of instability of Colles' fractures

    Acta Orthop Scand

    (1989)
  • P. Amadio

    Carpal kinematics and instability: A clinical and anatomic primer

    Clin Anat

    (1991)
  • P.W. Ballinger
  • M.E. Baratz et al.

    Wrist and hand measurement and classification schemes

  • Bindra RR, Cole RJ, Yamaguchi K, et al: A quantification of radius torsion angle by computerized tomo–graphy in...
  • R.L. Eisenberg

    Early radiology

  • R.H. Gelberman et al.

    Ulnar variance in Kienböck's disease

    J Bone Joint Surg

    (1975)
  • L.A. Gilula

    Carpal injuries: Analytic approach and case exercises

    Am J Roentgenol

    (1979)
  • L.A. Gilula et al.

    Wrist arthrography: An updated review

    J Med Imaging

    (1988)
  • L.A. Gilula et al.

    Post–traumatic ligamentous instabilities of the wrist

    Radiology

    (1978)
  • Cited by (29)

    • A Comparative Study of Thumb Metacarpal Morphology and Shape Categorization

      2023, Journal of Hand Surgery
      Citation Excerpt :

      Medical record numbers and the Vail-Summit Orthopaedics and Neurosurgery billing database were used to access patient radiographic images. A lateral radiograph was identified by superimposition of the condyles of the distal ends of the proximal phalange.6 Patients were included in the study if they met the age criteria (range, 18–75 years) and had appropriate radiographic images of the thumb MC.

    • Hand and Wrist Pain

      2016, Kelley and Firestein's Textbook of Rheumatology: Volumes 1-2, Tenth Edition
    • OARSI Clinical Trials Recommendations: Hand imaging in clinical trials in osteoarthritis

      2015, Osteoarthritis and Cartilage
      Citation Excerpt :

      The focus of the content is on radiography and MRI as the preferred imaging techniques with some content on ultrasound when appropriate. Typical hand radiographs can be acquired with multiple views5,6. The hand is usually evaluated with postero-anterior (PA) and oblique views, occasionally with more detailed magnified views of the joint of interest7.

    • Scaphoid overstuffing: The effects of the dimensions of scaphoid reconstruction on scapholunate alignment

      2013, Journal of Hand Surgery
      Citation Excerpt :

      Radiographs were obtained using a Fluoroscan III Imaging System C-Arm (Model #50700; Fluoroscan Imaging Systems, Inc., Northbrook, IL). The miniature C-arm was positioned to obtain standardized posteroanterior (PA) images of the wrist in both an unloaded neutral and a clenched fist position.6 The floor was marked with tape to the position of the plywood frame.

    • Hand and Wrist Pain

      2012, Kelley's Textbook of Rheumatology: Volume 1-2, Ninth Edition
    View all citing articles on Scopus

    Address reprint requests to Ken L. Schreibman, PhD, MD, Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216

    View full text