Ultrasound of the ulnar–palmar region of the wrist: normal anatomy and anatomic variations

Abstract

Ultrasound (US) assessment of the wrist is frequently used for the evaluation of carpal tunnel due to high frequency of local compression of the median nerve (MN), but the ulnar-palmar wrist region (UPWR) has received limited attention in the medical literature. The possibilities of US in the assessment of UPWR are therefore likely underestimated by sonologists. This review article is focused on the US assessment of the normal anatomy and anatomic variations of the UPWR. The anatomy of this region of the wrist is complex and less studied than the radial side. In an effort to simplify it and to present it didactically, we have divided this region in three parts on the basis of osseous landmarks. Our review indicates sonography is effective in identifying the UPWR and related disorders, and is thus a valuable tool for ensuring appropriate management of a variety of disorders.

Ultrasound of the Hook of Hamate Region: Pictorial Review

“…On ultrasound, the variant or aberrant muscle exhibits typical muscular pattern and can be identified within the Guyon's canal, which is normally devoid of any muscle. 30 The ADM in this region may overlie the neurovascular bundle and compress it against the TCL (Figure 12). Sometimes a robust aberrant muscle may be seen separating the ulnar artery and nerve (Figure 13).…”

“…The variant hypothenar muscles, especially when they are hypertrophied, may give rise to symptoms in this region due to neurovascular compression. On ultrasound, the variant or aberrant muscle exhibits typical muscular pattern and can be identified within the Guyon's canal, which is normally devoid of any muscle 30 . The ADM in this region may overlie the neurovascular bundle and compress it against the TCL (Figure 12).…”

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

“…Likewise, the ulnar end of the transducer is required to point toward the pisiform (which is on top of the distal triquetrum) for imaging the lunotriquetral ligament. Another important volar intrinsic carpal ligament is the pisohamate ligament [18]. The terminal portion of the ulnar nerve is divided into the deep branch of the ulnar nerve, the proper digital nerve of the little finger, and the common digital nerve of the fourth web space on top of this ligament.…”

Artifacts in Musculoskeletal Ultrasonography: From Physics to Clinics

“…Owing to advantages like portability, real-time assessment [ 1 , 2 ], and absence of radiation, high-resolution ultrasound (US) has emerged as the most useful imaging tool [ 3 , 4 ] in the diagnosis [ 5 , 6 , 7 ] and guided treatment [ 8 , 9 ] of musculoskeletal disorders. In addition to getting acquainted with scanning skills and sonoanatomy [ 10 , 11 ], medical professionals should also be aware of basic US physics and avoid or tackle the artifacts occurring during imaging.…”