US Area of Interest Given the superficial location of the joints, ligaments, muscles, tendons, and nerves of the hand and wrists, US is a useful tool in the assessment of chronic hand and wrist pain bolstered by the ability to readily perform and dynamic examination and evaluate the contralateral side [9,13]. US is optimally performed using high-frequency (10-15 MHz) linear transducers [11,13]. US can be used to identify synovitis, joint effusion, tenosynovitis, tendinopathy and tendon injury, pulley injury, carpal tunnel syndrome (CTS), and retained foreign body [6,13-16]. The American College of Rheumatology has concluded there is reasonable evidence to support the use of musculoskeletal US in patients without definitive diagnosis presenting with pain, swelling, or mechanical symptoms of the wrist, metacarpophalangeal, and interphalangeal joints; US is reasonable to evaluate tendon and soft tissue pathology of the hand and wrist and to assess for entrapment of the median or ulnar nerves [14]. In a study of patients referred from hand surgeons, US of the hand and wrist was contributory to the clinical assessment, defined as confirming the clinical suspicion or modifying the diagnostic/therapeutic plan in 76% of all patients and 67% of patient who presented without a history Chronic Hand and Wrist Pain of trauma [17]. Although there are many advantages to US evaluation for chronic hand and wrist pain, an interdisciplinary group of hand surgeons and radiologists recommended against the inclusion of US in the standard evaluation of scapholunate instability [18]. Variant 2: Adult. Chronic wrist pain. Radiographs normal or remarkable for nonspecific arthritis. Next imaging study. This variant is a guide on appropriate imaging use early in the assessment of chronic wrist pain, when standard radiographic projections are normal or show nonspecific arthritis.
Chronic Hand and Wrist Pain. US Area of Interest Given the superficial location of the joints, ligaments, muscles, tendons, and nerves of the hand and wrists, US is a useful tool in the assessment of chronic hand and wrist pain bolstered by the ability to readily perform and dynamic examination and evaluate the contralateral side [9,13]. US is optimally performed using high-frequency (10-15 MHz) linear transducers [11,13]. US can be used to identify synovitis, joint effusion, tenosynovitis, tendinopathy and tendon injury, pulley injury, carpal tunnel syndrome (CTS), and retained foreign body [6,13-16]. The American College of Rheumatology has concluded there is reasonable evidence to support the use of musculoskeletal US in patients without definitive diagnosis presenting with pain, swelling, or mechanical symptoms of the wrist, metacarpophalangeal, and interphalangeal joints; US is reasonable to evaluate tendon and soft tissue pathology of the hand and wrist and to assess for entrapment of the median or ulnar nerves [14]. In a study of patients referred from hand surgeons, US of the hand and wrist was contributory to the clinical assessment, defined as confirming the clinical suspicion or modifying the diagnostic/therapeutic plan in 76% of all patients and 67% of patient who presented without a history Chronic Hand and Wrist Pain of trauma [17]. Although there are many advantages to US evaluation for chronic hand and wrist pain, an interdisciplinary group of hand surgeons and radiologists recommended against the inclusion of US in the standard evaluation of scapholunate instability [18]. Variant 2: Adult. Chronic wrist pain. Radiographs normal or remarkable for nonspecific arthritis. Next imaging study. This variant is a guide on appropriate imaging use early in the assessment of chronic wrist pain, when standard radiographic projections are normal or show nonspecific arthritis.