Sonoanatomy and Stepwise/Systematic Ultrasound Examination of the Extrinsic/Intrinsic Wrist Ligaments

Abstract

Ultrasound has emerged as the most useful imaging tool for investigating wrist and hand disorders, with several published ultrasound protocols having demonstrated their practicality in scanning the wrist tendons and nerves. However, ligaments of the wrist are networked in a complex manner, deterring sonographers from examining them with an organized strategy. Furthermore, because of the non-parallel alignment between the radiocarpal, mid-carpal, and carpal–metacarpal joints, precise recognition of the carpal bones is challenging, although ultrasound is paramount for visualizing the wrist ligaments. In this regard, the current article for point of view aims to elaborate sonoanatomy of the carpal bones and to present a stepwise systematic approach for navigating the extrinsic and intrinsic wrist ligaments.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Wrist and Hand

“…Ultrasound allows a comprehensive assessment of the extrinsic and intrinsic wrist ligaments as hyperechoic bands connecting the individual bones. 7 It is essential to direct the sound beam as perpendicular as possible to avoid anisotropy artifact that can otherwise be misinterpreted as a pathology (e.g., edema, tear). A ligament tear is suspected if the fibers are discontinuous or the ligament is absent.…”

Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma

“…Either a rolled towel or a cylindrical US gel tube allowed proper wrist positioning, namely mild palmar flexion and mild dorsal flexion for dorsal and palmar ligaments, respectively. Wrist ligaments were imaged along their longitudinal axis using the distal radius, distal ulna, and carpal bones as anatomical landmarks [13,18], according to a previously described imaging protocol which also included dynamic evaluation and comparison with the contralateral healthy side (▶ Table 1) [19]. Schematic drawings of intrinsic and extrinsic wrist ligaments are shown in ▶ Fig.…”

“…Particularly, MRA is the best imaging method to visualize wrist ligaments and assess related injuries [6,7], although it is expensive and often unavailable in the setting of acute trauma. Preliminary results have been published on ultrasound (US) of wrist ligaments, which is cost-effective, noninvasive, and largely available [8,9,10,11,12,13]. Additionally, latest-generation US systems allow for the visualization of small superficial structures of the wrist with high resolution [14,15].…”

“…Additionally, latest-generation US systems allow for the visualization of small superficial structures of the wrist with high resolution [14,15]. However, most US studies to date have focused on the evaluation of wrist ligaments in normal subjects [8,9,10,11,12,13] or cadavers [16].…”

Ultrasound Diagnosis and Guided Intervention of Musculoskeletal/Neuromuscular Pathology 2022

“…Wu et al [16] further explored the anatomy of ischiofemoral spaces, utilizing cadaveric models and magnetic resonance imaging, and discussed the application of ultrasound in diagnosing and guiding injections for ischiofemoral impingement syndrome. Lastly, Wang et al [17] provided an in-depth analysis of the sonoanatomy of the carpal bones and presented a systematic approach for navigating wrist ligaments, both extrinsic and intrinsic.…”