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Imaging of the wrist

Nuffield Orthopaedic Centre, Oxford, UK

• Multislice CT and MRI are both useful in the diagnosis of occult fractures.
  
• Ultrasound is the investigation of choice for suspected tendon pathology.
  
• Gadolinium-enhanced MRI is the gold standard for evaluating the viability of the proximal pole of the scaphoid following non-union.
  
• Intrinsic ligament injury and triangular fibrocartilage disruptions are best visualized using MR arthrography.
  
• Both ultrasound and MRI can demonstrate the presence of synovitis and erosions earlier than plain radiographs.
  
• Soft-tissue masses of the wrist and hand are usually benign. The most common mass is a ganglion. The commonest solid lesion is a giant cell tumour of the tendon sheath.
  

This article reviews the imaging of pathological conditions of the wrist according to the clinical presentation: acute injury, chronic focal pain, nerve entrapment, chronic diffuse pain and masses. The appropriate use of the various imaging modalities is discussed.