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Imaging of the wrist

Department of Radiology, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK

View larger version (121K): [in a new window]   Figure 1. Axial CT scan demonstrating a fracture of the hook of the hamate (white arrow) that was not seen on plain radiography. An incidental intraosseous ganglion (black arrow) is present.

View larger version (112K): [in a new window]   Figure 2. (a) Coronal T1 weighted image demonstrating a low signal fracture line (arrows) of the distal radius that was radiographically occult. (b) Same patient as (a). Coronal short tau inversion recovery image demonstrating high signal surrounding the distal radius fracture indicating marrow oedema and haemorrhage.

View larger version (126K): [in a new window]   Figure 3. Coronal short tau inversion recovery image demonstrating high signal throughout the scaphoid (arrow) indicating a fracture.

View larger version (136K): [in a new window]   Figure 4. Coronal gradient echo image demonstrating acute disruption of the triangular fibrocartilage (black arrow) with dislocation of the distal radioulnar joint (white arrow).

View larger version (59K): [in a new window]   Figure 5. Longitudinal ultrasound image demonstrating a rupture of the flexor digitorum profundus tendon with retraction of the tendon ends (arrow). The distal, middle and proximal phalanges are marked (DP, MP and PP, respectively).

View larger version (118K): [in a new window]   Figure 6. Axial CT image demonstrating non-union of a scaphoid fracture with a Herbert screw in situ.

View larger version (112K): [in a new window]   Figure 7. Coronal (a) T1 and (b) T2 weighted images, respectively, demonstrating low signal in the proximal pole fragment of the scaphoid consistent with avascular necrosis.

View larger version (129K): [in a new window]   Figure 8. Coronal short tau inversion recovery image demonstrating bone marrow oedema in the lunate consistent with early Kienbock's disease.

View larger version (100K): [in a new window]   Figure 9. (a) Lateral radiograph of the wrist demonstrating dorsal intercalated segmental instability (DISI). The scapholunate angle is typically greater than 60 degrees. (b) Lateral radiograph of the wrist demonstrating volar intercalated segmental instability (VISI). The scapholunate angle is typically less than 30 degrees.

View larger version (148K): [in a new window]   Figure 10. Anteroposterior radiograph of the wrist demonstrating widening of the scapholunate gap to >2 mm (this has been likened to a diastema, hence the Terry Thomas sign).

View larger version (106K): [in a new window]   Figure 11. Coronal T1 fat saturated MR arthrogram demonstrating the normal scapholunate ligament (long white arrow), the lunotriquetral ligament (short white arrow) and the triangular fibrocartilage disc (arrowhead).

View larger version (127K): [in a new window]   Figure 12. Coronal T1 fat saturated MR arthrogram demonstrating contrast extending between the scaphoid and lunate (arrow) consistent with a tear.

View larger version (129K): [in a new window]   Figure 13. Radiocarpal arthrogram with contrast seen to enter the distal radioulnar joint (arrow) consistent with a triangular fibrocartilage disc perforation (arrowhead).

View larger version (105K): [in a new window]   Figure 14. Coronal T1 fat saturated MR arthrogram demonstrating contrast extending across the triangular fibrocartilage disc which is ruptured on the ulnar aspect (arrow).

View larger version (120K): [in a new window]   Figure 15. Axial T2 fat saturated image demonstrating subluxation of the distal radioulnar joint. The ulna should lie between the subtended lines.

View larger version (89K): [in a new window]   Figure 16. Longitudinal ultrasound image demonstrating flexor tenosynovitis at the wrist. The normal fibrillar echotexture of the tendon is preserved (arrowheads), with low echogenicity fluid seen surrounding the tendon (arrows).

View larger version (157K): [in a new window]   Figure 17. Coronal T1 weighted image demonstrating fusiform low signal thickening of extensor compartment 1 indicating de Quervain's tenosynovitis.

View larger version (106K): [in a new window]   Figure 18. Transverse ultrasound scan of the carpal tunnel demonstrating a ganglion (long arrow) which compresses the median nerve (arrowhead).

View larger version (88K): [in a new window]   Figure 19. Longitudinal ultrasound scan of the median nerve demonstrating relative swelling of the median nerve (large arrow) prior to entering the carpal tunnel (indicated by small arrow).

View larger version (108K): [in a new window]   Figure 20. Longitudinal ultrasound scan of the dorsum of the wrist demonstrating synovial hypertrophy and increased flow on Doppler interrogation in a patient with psoriatic arthritis.

View larger version (95K): [in a new window]   Figure 21. Longitudinal ultrasound scan of the index metacarpophalangeal joint demonstrating synovial hypertrophy and increased flow on power Doppler in a patient with rheumatoid arthritis.

View larger version (170K): [in a new window]   Figure 22. Coronal short tau inversion recovery image demonstrating early synovitis of the hands (arrows) in a rheumatoid patient with a normal plain radiograph.

View larger version (79K): [in a new window]   Figure 23. Longitudinal ultrasound scan of the dorsum of the wrist demonstrating a well defined low echogenicity mass (arrows) with posterior acoustic enhancement consistent with a ganglion.

View larger version (115K): [in a new window]   Figure 24. Axial T2 fat saturated image demonstrating a well defined high/fluid signal mass with deep to the extensor tendons consistent with a ganglion.

View larger version (82K): [in a new window]   Figure 25. (a) Coronal T1 weighted image demonstrating a homogeneous high signal mass in the hypothenar eminence consistent with a benign lipoma. (b) Same patient as (a). Coronal short tau inversion recovery image demonstrating homogeneous low signal throughout the lipoma.

View larger version (130K): [in a new window]   Figure 26. Coronal T1 weighted image demonstrating the classic appearances of a fibrolipomatous hamartoma. There is fatty tissue interspersed between the splayed fibres of the median nerve (arrows).

View larger version (63K): [in a new window]   Figure 27. Transverse ultrasound images of both wrists obtained through Guyon's canal demonstrating an anomalous abductor digitus minimus muscle (arrowheads) displacing the ulnar nerve (long arrow). Compare with the normal image on the left.

View larger version (53K): [in a new window]   Figure 28. Axial (a) T1 weighted and (b) T2 fat saturated images demonstrating a well defined solid mass in the middle finger adjacent to the flexor tendon consistent with a giant cell tumour of the tendon sheath. Note small low signal foci on both sequences indicating haemosiderin deposition.