Imaging of the wrist

Abstract

• MR or CT is advocated in the assessment of radiographically occult fractures. • The intrinsic ligaments of the wrist are better visualized at 3.0-T MRI than at 1.5-T MRI; however, MR or multidetector CT arthrography is the most sensitive at detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears. • MR is more sensitive at detecting scapholunate ligament tears than lunotriquetral ligament tears. • TFCC tears can be divided into traumatic or degenerative tears, the latter being related to ulnar impaction syndrome. • Chronic wrist pain as a result of trauma may be secondary to scaphoid avascular necrosis, malunion, non-union, scapholunate advanced collapse and scaphoid non-union advanced collapse wrist or chronic regional pain syndrome. • Specific ulnar-sided wrist pain has its own unique causes that are optimally imaged with MR. • Doppler ultrasound and dynamic-enhanced MRI are the most sensitive imaging tools for diagnosing and monitoring synovitis in inflammatory arthropathies. • Most masses in the wrist and hand are benign and have typical imaging appearances. This article details the current imaging modalities utilized in the assessment of wrist pathology, with particular emphasis on recent developments and difficult areas. A stepwise approach for the assessment of wrist pathology in the context of clinical presentation will be discussed. The radiologist's role in the evaluation of wrist pain continues to evolve with the growing development of new techniques in order to evaluate with greater sensitivity the disorders affecting the complex joint and ligamentous structures of the wrist. The imaging strategy for wrist pathology begins with radiographs, with the use of further imaging such as ultrasound, CT, MRI and arthrography techniques if the diagnosis remains unclear.