Sonography of Masses of the Wrist and Hand

Abstract

capsule of the wrist (60-70%) near the dorsal band of the scapholunate ligament. A less common location is the radial aspect of the volar face of the wrist, close to the radial artery, and the palmar aspect of the fingers, near the A1 pulleys. Ganglia on sonography usually appear as hypoechoic or anechoic, well-delineated masses that can show internal septa and are usually located near a joint or a tendon sheath [1,2,[4][5][6][7] (Fig. 1).The sonographic appearance of ganglia depends on their size and chronicity [6]. Larger cysts are often anechoic, and old lesions are echogenic and show internal thick septa. Color Doppler sonography can show a hypervascular wall in symptomatic patients (Fig. 2), although vascularity does not always correlate with symptoms and vice versa. Smaller dorsal ganglia, also known as occult ganglia, are difficult to detect clinically and frequently cause local pain and limitation of movement [7]. Sonography shows them as 1-to 3-mm unilocular, anechoic cysts located near the dorsal band of the scapholunate ligament (Fig. 3). Sonography can assess their relation to the overlying extensor tendons and to the posterior interosseus nerve. In addition, sonography can assess the scapholunate ligament [8,9] and rule out effusions of the radiocarpal joint.Volar wrist ganglia usually are found near the flexor carpi radialis tendon and often displace the radial artery and its palmar branch. Color Doppler sonography easily assesses the internal flow of the artery and can differentiate ganglia from arterial pseudoaneurysms. The differential diagnosis of volar ganglia also includes tenosynovitis of the

Comparison of Ultrasonography and Magnetic Resonance Imaging for Diagnosis of Soft Tissue Masses of the Hand and Wrist

“…Giant cell tumor of the tendon sheath is also known as localized nodular tenosynovitis or focal pigmented villonodular synovitis, due to its pathological appearance (1,9,11). It is the second most common lesion of the hand and wrist (6,8,9,11).…”

“…It is the second most common lesion of the hand and wrist (6,8,9,11). And also, it is the most common soft tissue tumor of the hand and wrist (1,12). Middleton et al defined ultrasonographic appearance of these tumors as hypoechoic and mostly homogenous (11).…”

Sonographic Appearance of the Posterior Interosseous Nerve at the Wrist

“…Similar to other body regions, sonography may reveal focal caliber changes due to compression or neuroma formation, as well as identify impinging structures such as osteophytes and dorsal wrist ganglia. 7,12,[14][15][16] Future clinical experience with distal posterior interosseous nerve sonography will further define the role of diagnostic sonography in this region. Therapeutically, sonographic guidance provides the opportunity to precisely place needles or other instruments within or in close proximity to the distal posterior interosseous nerve.…”

“…First, when appropriate, the posterior interosseous nerve could be included in the sonographic evaluation of patients presenting with dorsal wrist pain syndromes, including dorsal wrist ganglia. 7 Second, Figure 1. A, Unembalmed cadaveric dissection of the distal posterior interosseous nerve within the fourth dorsal wrist extensor compartment.…”

“…[1][2][3][4][5][6][7] Regardless of etiology, pain mediation via the terminal branches of the posterior interosseous nerve appears to play an important role in the clinical syndrome of dorsal wrist pain. 2,3,8 Consequently, complete or partial wrist denervation has been used as palliative treatment of chronic dorsal wrist pain when curative or reconstructive procedures are not feasible.…”