Ultrasound is a useful imaging modality for evaluation of the elbow, wrist and hand. Allowing high-resolution imaging of anatomy while simultaneously allowing dynamic evaluation of the joint, tendons and ligaments.

Wrist and Hand

There are multiple approaches to imaging the wrist with ultrasound. The exam is easily tailored to a specific painful area.

Hand & Fingers

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.

Stenosing tenosynovitis
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.

The Dorsal Wrist

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.

Ventral Wrist

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.

Elbow

The elbow comprises of three regions, the anterior medial, lateral and posterior, each with its own group of nerves, vessels and muscular involvement.

The Posterior Elbow

Posterior impingement syndrome
A common condition seen in many throwing sports which causes pain in the posterior elbow.specifically the olecranon fossa is injured after repetitive force leads to posterior impingement. Ultrasound can provide helpful clues in evaluation of osteophyte impingemnet and synovitis.

Olecranon bursitis
Olecranon bursitis, has numerous causes, including trauma, chronic repetitive micro-trauma and inflammatory diseases such as uric acid deposition in gout, extraarticular deposition of rheumatoid factor in rheumatoid arthritis and calcium pyrophosphate deposition, otherwise known as pseudogout.

Triceps Tendinopathy
Forced loading to a contracting triceps has been shown to be the main mechanism of triceps tendon pain and avulsion. A variety of athletes and workers, including weight-lifters, mechanics, laborers, housewives and childcare workers, can experience triceps pain secondary to chronic repetitive tasks. Ultrasound iamging using dynamic flexion and extension identify pathology not seen in static imaging.

Anterior Medial Elbow

Ulnar collateral ligament (UCL) is the primary dynamic stabilizer during extension of the elbow, a motion commonly performed in throwing sports “UCL injury will commonly present with complaints of vague medial elbow pain with reduced velocity. Ultrasound can specifically assess both the integrity of the UCL and widening of the medial joint space.

Ulnar nerve entrapment/cubital tunnel syndrome
Elbow pain coupled with numbness of the 4th and 5th digits is characteristic of cubital tunnel syndrome or ulnar nerve entrapment. Movemnet of the ulnar nerve can produce nerve symptoms along with a painful snap. This is often seen in the throwing elbow. This can be seen dynamically on ultrasound.

Medial epicondylitis (Golfer’s Elbow)
A common syndrome encountered in sports medicine and is pain, with or without tears, of the tendon attachment at the origin of the common flexor tendons of the forearm termed the medial epicondylitis.

Lateral Elbow

Radial collateral ligament (LCL) injury
This condition, known as posterior- lateral rotary instability, can be secondary to trauma or chronic repetitive action. On ultrasound one can see the ski slope appearance of the ligament extending form the lateral elbow and its articulation with the radius bone. A defect can be seen deep to the muscles of the common extensor tendon

Lateral epicondylitis ( Tennis Elbow)
Lateral epicondylitis, refers to persistent pain at the extensor tendons of the wrist. pain can be felt on a static muscle contraction opposing extension at the middle finger, as well tenderness to palpation over the lateral epicondyle

Wrist & Hand

There are multiple approaches to imaging the wrist with ultrasound. The exam is easily tailored to a specific painful area.

Hand & Fingers

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.

Stenosing tenosynovitis
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.

The Dorsal Wrist

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.

Ventral Wrist

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.

Elbow

The elbow comprises of three regions, the anterior medial, lateral and posterior, each with its own group of nerves, vessels and muscular involvement.

The Posterior Elbow

Posterior impingement syndrome
A common condition seen in many throwing sports which causes pain in the posterior elbow.specifically the olecranon fossa is injured after repetitive force leads to posterior impingement. Ultrasound can provide helpful clues in evaluation of osteophyte impingemnet and synovitis.

Olecranon bursitis
Olecranon bursitis, has numerous causes, including trauma, chronic repetitive micro-trauma and inflammatory diseases such as uric acid deposition in gout, extraarticular deposition of rheumatoid factor in rheumatoid arthritis and calcium pyrophosphate deposition, otherwise known as pseudogout.

Triceps Tendinopathy
Forced loading to a contracting triceps has been shown to be the main mechanism of triceps tendon pain and avulsion. A variety of athletes and workers, including weight-lifters, mechanics, laborers, housewives and childcare workers, can experience triceps pain secondary to chronic repetitive tasks. Ultrasound iamging using dynamic flexion and extension identify pathology not seen in static imaging.

Anterior Medial Elbow

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.

Lateral Elbow

Radial collateral ligament (LCL) injury
This condition, known as posterior- lateral rotary instability, can be secondary to trauma or chronic repetitive action. On ultrasound one can see the ski slope appearance of the ligament extending form the lateral elbow and its articulation with the radius bone. A defect can be seen deep to the muscles of the common extensor tendon

Lateral epicondylitis ( Tennis Elbow)
Lateral epicondylitis, refers to persistent pain at the extensor tendons of the wrist. pain can be felt on a static muscle contraction opposing extension at the middle finger, as well tenderness to palpation over the lateral epicondyle