Wrist and Hand
There are multiple approaches to imaging the wrist with ultrasound. The exam is easily tailored to a specific painful area.
Ulnar collateral ligament (UCL) injury
Avulsion or rupture of the ulnar collateral ligament (UCL) of the thumb is essentially synonymous with ‘skiers thumb’. It consists of an acute injury by forcibly abducting and hyperextending the thumb during a fall or trauma. Ultrasound is helpful in identifying not only the tear but whether there is significant retraction of the proximal fragment classed as a Stener lesion. In these cases a surigical repair is required.
Otherwise known as ‘trigger finger’ becuae of the rigid movemenst of joint. It develops due to repetitive microinjury from frequent flexion-extension movements of the fingers. Ultrasound findings include – thickening of the pulley that overlies the metacarpal heads holding the tendon in place and inflammation of the synovial sheath around the tendons. Trigger finger is treated successfully with injection therapy.
De Quervain Tenosynovitis
Inflammation of the tendons involving the first extensor tendon compartment of the wrist. This compartment contains the tendons of the thumb, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB).
Ultrasound is very often ued to diagnose fluid within the first compartment and tendon thickening.Ultrasound is often used to guide corticosteroid injections into the compartment
The second, third, fourth & fits extensor compartments contains the extensor tendons of the hand and wrist. Injury to the scapholunate ligament and the triangular fibrocartiladge complex (TFCC) can be examined.
Carpal Tunnel Syndrome
Ultrasound is a very accurate tool to evaluate the proximal carpal and distal carpal tunnel, with particular attention to the shape and structure of the median nerve. Carpal tunnel syndrom is the compression of the median nerve through the wrist and be can be diagnosd with ultrasound by examing the nerve from the elbow all the way to the hand.
The Guyon’s canal and ulnar nerve can be assessed. The ulnar nerve is can become inflammed and compressed at the wrist causing pain , numbness and pins andneedles.