Imaging of the Hand and Wrist: Techniques and Applications

Description

In the past, radiographs of the hand have been described as the “skeleton’s calling card”, showing manifestations of many different diseases. As hand and wrist imaging has become increasingly sophisticated, this observation has become more true than ever. This is a comprehensive, up-to-date textbook on imaging of the hand and wrist. In the first part of the book, the various imaging techniques are discussed in detail. Individual chapters are devoted to radiography, ultrasound, CT, MRI and nuclear medicine. The second part of the book gives an authoritative review of the various pathologies that may be encountered in the hand and wrist, encompassing congenital and developmental abnormalities, trauma, and the full range of localized and systemic disorders. Each chapter is written by an acknowledged expert in the field, and a wealth of illustrative material is included. This book will be of great value to musculoskeletal and general radiologists, orthopaedic surgeons and rheumatologists. Cover Contents Radiography and Arthrography S. G. Davies 1 Introduction 2 Radiographic Projections 2.1 Radiographic Projections of the Wrist 2.1.1 PA and Lateral Projections of the Wrist 2.2 Radiographic Projections of the Scaphoid Carpus 2.2.1 AP with Ulnar Deviation 2.2.2 Anterior Oblique (Pronated Oblique) 2.2.3 Posterior Oblique (Supinated Oblique) 2.2.4 Lateral 2.3 Radiographic Projections of the Hand 2.3.1 PA Hand 2.3.2 PA Anterior Oblique Hand 2.3.3 Lateral Hand 2.3.4 Posterior Oblique of Both Hands 2.4 Radiographic Projections of the Phalanges 2.4.1 PA Phalanges 2.4.2 Lateral Phalanges 2.5 Radiographic Evaluation of the Thumb 2.5.1 AP Thumb 2.5.2 Lateral Thumb 2.5.3 PA Thumb 3 Radiographic Technique 3.1 Computed Radiography (CR) 3.2 Direct Radiography (DR) 4 Additional Projections and Fluoroscopy 4.1 Carpal Instability Series—Static Evaluation 4.1.1 Technique 4.1.2 Evaluation 4.2 Dynamic Evaluation—Fluoroscopy 4.2.1 Technique 4.2.2 Evaluation 5 Measurements 5.1 Ulna Variance 5.2 Radial Inclination 5.3 Radial Length (Radial Height) 5.4 Palmar Tilt (Volar Tilt or Volar Inclination) 5.5 Scapholunate Angle 5.6 Capitate–Lunate Angle 5.7 Carpal height 6 Arthrography References Computed Tomography of Hand and Wrist Sri Priya Suresh and Tishi Ninan 1 Introduction 2 Computed Tomography Techniques 2.1 Patient Positioning 2.2 Technique 2.3 CT Arthrogram 3 Clinical Applications 3.1 Acute Trauma 3.1.1 Fractures of Distal Radius and Ulna 3.2 Fractures of Carpal Bones 3.2.1 Scaphoid Fractures 3.2.2 Lunate Fractures 3.2.3 Triquetral Fractures 3.2.4 Pisiform Fractures 3.2.5 Trapezium and Trapezoid Fractures 3.2.6 Capitate Fractures 3.2.7 Hamate Fractures 3.3 Fractures of Metacarpals 3.4 Dislocations 3.5 Fracture Union 3.5.1 Sequelae of Trauma (Scapho Lunate Advanced Collapse and Scaphoi 3.6 Ligament Injury: CT Arthrography 3.7 Arthropathies 3.8 Tumor Imaging 4 Modern Advances 5 Conclusion References MRI and MR Arthrography Emma L. Rowbotham and Andrew J. Grainger 2 Technical Considerations 2.1 Positioning 2.2 Imaging Planes 2.2.1 Axial 2.2.2 Coronal 2.2.3 Sagittal 2.3 Sequences 2.3.1 T1 Weighted Imaging 2.3.2 Fast Spin Echo 2.3.3 Short T1 Inversion Recovery 2.3.4 Gradient Echo 2.3.5 Typical Protocols 2.4 Artefacts 2.4.1 Motion Artefact 2.4.2 Pulsation Artefact 2.4.3 Chemical Shift Phenomena 2.4.4 Susceptibility Artefact 2.4.5 Truncation Artefacts 2.4.6 Magic Angle Effect 2.4.7 Aliasing or Wraparound Artefact 3 Imaging Findings 3.1 Osseous Structures 3.2 Tendons 3.3 Triangular Fibrocartilage Complex 3.4 Ligaments 3.4.1 The Intrinsic Ligaments 3.4.2 The Extrinsic Ligaments 3.4.3 The Ulnar Collateral Ligament of the Thumb 3.5 Hyaline Cartilage 4 MR Arthrography 4.1 Protocols 4.2 Injection of Contrast 4.3 Artefacts 4.4 Indirect Arthrography 4.5 Alternative Modalities 5 7T Imaging References Radionuclide Imaging of the Hand and Wrist Gopinath Gnanasegaran, Nicola J. R. Mulholland, Bo Povlsen, and Ignac 1 Introduction 2 Techniques 2.1 Bone Scintigraphy 2.2 Conventional 2 Phase Bone Scan With X-ray Registration 2.3 Multislice SPECT/CT 2.3.1 SPECT/CT Imaging Protocol 2.4 Other Nuclear Medicine Techniques 3 Clinical Applications 3.1 Acute Fractures 3.2 Fractures of Uncertain Age 3.3 Arthritis 3.3.1 Osteoarthritis 3.3.2 Inflammatory Arthritis 3.3.3 Infection 3.3.4 Avascular Necrosis 3.3.5 Miscellaneous 4 Conclusion Ultrasound Imaging Techniques and Procedures Stefano Bianchi, René de Gautard, Giorgio Tamborrini, and Stefan Mari 2 Technique of Examination and Normal US Appearance 3 Dorsal Aspect 4 Palmar Aspect 5 Key Points 5.1 Advantages of Ultrasound in Wrist and Hand Assessment 5.2 Disadvantages of Ultrasound in Wrist and Hand Assessment 5.3 Operator Requisites for US Examination in Wrist and Hand Assessm 5.4 Basic Principles of US Technique of Examination in Wrist and Ha References Skeletal Development and Aging Jim Carmichael, Lil-Sofie Ording Mü ller, and Karen Rosendahl 1 Introduction 2 Embryology of the Hand—Foetal Period 3 Postnatal Growth of the Hand Skeleton 3.1 Carpus 3.2 Metacarpals 3.3 Phalanges 3.4 Radius and Ulna 3.5 Maturation of the Bone Marrow 4 Assessment of Bone Age References Congenital and Developmental Abnormalities Emily J. Stenhouse, James J. R. Kirkpatrick, and Greg J. Irwin 2 Imaging 3 Classification 4 Failure of Formation 4.1 Transverse 4.2 Longitudinal 4.2.1 Radial 4.2.2 Central 4.2.3 Ulnar 5 Failure of Differentiation 5.1 Syndactyly 5.2 Arthrogryposis 5.3 Camptodactyly 5.4 Clinodactyly 5.5 Congenital Thumb Flexion Deformities 6 Duplication 6.1 Post-Axial Polydactyly 6.2 Pre-Axial Polydactyly 6.3 Central Polydactyly 6.4 Mirror-Hand and Mirror-Hand Spectrum 7 Overgrowth Conditions 7.1 Nerve Territory Oriented Macrodactyly and Lipomatous Macrodactyly 8 Undergrowth Including Hypoplastic Thumb 9 Constriction Ring Syndrome 10 Generalized Skeletal Abnormalities 10.1 Achondroplasia Group 10.2 Short Rib-Polydactyly Group 10.3 Multiple Epiphyseal Dysplasia and Pseudoachondroplasia Group 10.4 Metaphyseal Disorders 10.5 Dysostosis Multiplex Group 10.6 Dysplasias with Decreased Bone Density 10.7 Sclerosing Bone Dysplasias 10.8 Increased Limb Length 11 Summary References Hand Trauma Anand Kirwadi, Nikhil A. Kotnis, and Andrew Dunn 1 Introduction 2 Volar Soft Tissue Injuries 2.1 Flexor Tendons 2.2 Annular Pulleys 2.3 Volar Plate 3 Extensor Mechanism Injuries 3.1 Anatomy 3.2 Mallet Injury (Zone 1) 3.3 Boutonniere Deformity (Zone III Injury) 3.4 Boxer’s Knuckle (Zone V Injury) 4 Collateral Ligament Injuries 4.1 Ulnar Collateral Ligament of the Thumb 4.2 Radial Collateral Ligament 5 Fractures 5.1 Thumb Fractures 5.1.1 Bennett Fracture 5.1.2 Rolando Fracture 5.2 Boxer’s Fracture 5.3 Intra-articular Fractures and Dislocations of the Carpometacarpal 5.4 Phalangeal Fractures 5.5 Interphalangeal Joint Dislocations 6 Conclusion References Imaging of Wrist Trauma Nigel Raby 1 Introduction 1.1 Radiographic Anatomy and Projections 1.2 Analysis of Radiographs 1.3 Ligamentous Anatomy of Wrist 2 Injuries of Radius and Ulna 2.1 Children 2.2 Adults 2.3 Distal Radio-Ulnar joint 3 Carpal Injuries 3.1 Scaphoid 3.2 Other Carpal Fractures 3.3 Carpal Dislocations 4 Carpo-Metacarpal Injuries 5 Acute Soft Tissue Injuries 6 Chronic/Overuse Injuries 7 Summary/Key Points Wrist Instability Milko C. de Jonge, G. J. Streekstra, S. D. Strackee, R. Jonges, an 1 Introduction 2 Anatomy 3 The Clinical Problem 4 Imaging 4.1 Conventional Radiography 4.2 Signs and Angles 4.3 Type I Instabilities 4.4 Type II Instabilities 4.5 Other Imaging Modalities 4.5.1 MR Imaging and CT 4.5.2 Cineradiography 5 Understanding of Wrist Biomechanics by 4D Imaging 6 Treatment and Clinical Perspective References Nerve Entrapment Syndromes Stefano Bianchi, Lucio Molini, Marie Claude Schenkel, and Thierry Gla 1 Introduction 2 Normal Anatomy and US Anatomy of PN 3 Pathological Physiology of CN 4 Anatomy of the Nerves of the Wrist and Hand 5 Technique of US Examination and Normal US Anatomy 6 CTS 6.1 Changes in MN Appearance 6.2 Changes in CT Appearance 6.3 Demonstration of Compressive Causes 7 Guyon’s Tunnel Syndrome 8 Disorders of the Superficial Branch of the RN 9 Key Points References Osteonecrosis and Osteochondrosis Waqar A. Bhatti and Andrew J. Grainger 1 Introduction 2 Aetiology 3 Imaging Techniques 3.1 Radiography 3.2 Computed Tomography 3.3 Magnetic Resonance Imaging 3.4 Bone Scintigraphy 4 Scaphoid 4.1 Preiser’s Disease 5 Lunate 5.1 Kienbö ch’s Disease 5.1.1 Imaging 5.1.2 Staging of Kienbö ch’s Disease 6 Capitate 7 Hamate 8 The Hand Metabolic and Endocrine Disorders Giuseppe Guglielmi and Silvana Muscarella 1 Introduction 2 Classification of Osteoporosis 3 Diagnosis of Osteoporosis 3.1 Conventional Radiography 3.2 Peripheral Dual-Energy X-Ray Absorptiometry 3.3 Peripheral Quantitative Computed Tomography 3.4 Quantitative Ultrasound 3.5 Magnetic Resonance 4 Other Metabolic and Endocrine Disorders 4.1 Acromegaly and Gigantism 4.2 Hypopituitarism 4.3 Thyroid Disorders 4.4 Hyperparathyroidism 4.5 Rickets and Osteomalacia 4.6 Hypoparathyroidism 4.7 Scurvy 5 Conclusions 6 Key Points References Arthritis Andrew J. Grainger 1 Introduction 2 The Inflammatory Arthritides 2.1 Plain Film General Principles 2.1.1 Soft Tissue Swelling 2.1.2 Alteration in Joint Space 2.1.3 Bone Changes 2.1.4 Bone Alignment 2.2 Rheumatoid Arthritis 2.2.1 Soft Tissue Changes and Bone Density 2.2.2 Joint Space Loss 2.2.3 Erosion 2.2.4 Malalignment and Ankylosis 2.2.5 Secondary OA 2.2.6 Other Soft Tissue Changes 2.3 Seronegative Arthritis 2.3.1 Psoriatic Arthritis 2.3.2 Other Seronegative Arthritides 2.4 Juvenile Idiopathic Arthritis 2.5 Advanced Imaging Techniques in Inflammatory Arthritis 2.5.1 Synovitis and Effusion 2.5.2 Bone Erosion and Marrow Oedema 2.5.3 Enthesitis 2.5.4 Tendon and Soft Tissue Disease 2.5.5 Application to Clinical Practice 2.5.6 Other Imaging Modalities 2.6 Monitoring Disease Progression 3 The Crystal Arthritides 3.1 Gout 3.1.1 Imaging Findings 3.2 Calcium Pyrophosphate Crystal Deposition Disease (CPPD) 3.2.1 Imaging Findings 3.3 Calcium Hydroxyapatite Crystal Deposition Disease 3.3.1 Periarticular HA Deposition Disease 3.3.2 Intra-Articular HA Deposition Disease 4 Osteoarthritis (OA) 4.1 Plain Film Findings 4.2 Findings at Specific Joints 4.2.1 Interphalangeal Joints 4.2.2 Metacarpophalangeal Joints 4.2.3 The Wrist 4.3 Inflammatory OA 4.3.1 Radiographic Features 4.4 Advanced Imaging Techniques 5 Connective Tissue Disease 5.1 Scleroderma 5.2 Dermatomyositis and Polymyositis 5.3 Systemic Lupus Erthematosus 5.4 Rheumatic Fever (Jaccoud’s Arthropathy) 5.5 Mixed Connective Tissue Disease References Soft Tissue and Bone Infections Rainer R. Schmitt and Georgios Christopoulos 1 General Aspects 1.1 Introduction 1.2 Routes of Infection 1.3 Imaging Techniques 2 Soft-Tissue Infections 2.1 Soft-Tissue Infections at the Fingers and Midcarpus 2.2 Supporative Flexor Tenosynovitis 2.3 Tuberculosis of the Tendon Sheaths 2.4 Infections of the Deep Palmar Spaces 2.5 Gangrenous Infection 2.6 Pyomyositis and Necrotizing Fasciitis 3 Osteomyelitis 3.1 Time Course of Osteomyelitis 3.1.1 Acute Osteomyelitis 3.1.2 Subacute Osteomyelitis 3.1.3 Chronic Osteomyelitis 3.2 Etiology of Osteomyelitis 3.2.1 ‘ ‘Primary’’ (Hematogenous) Osteomyelitis 3.2.2 ‘ ‘Secondary’’ (Spread From Soft Tissues) Osteomyelitis 3.2.3 Special Forms of Osteomyelitis 3.3 Differential Diagnosis 4 Infectious Arthritis 4.1 Bacterial Arthritis 4.2 Tuberculous Arthritis 5 Rare Infections of the Hand Skeleton 5.1 Syphilis 5.2 Gonococcal Arthritis 5.3 Leprosy (Hansen’s Disease) 5.4 Rare and Atypical Infections of Bacterial Origin 5.5 Viral Infections 5.6 Fungal Infections 5.7 Parasitic Infections 6 Key Points References Tumours and Tumour-Like Lesions of Bone Nikhil A. Kotnis, A. Mark Davies, and Steven L. J. James 2 Benign Bone Tumours of the Hand and Wrist 2.1 Benign Cartilaginous Tumours 2.1.1 Enchondroma 2.1.2 Periosteal Chondroma 2.1.3 Osteochondroma 2.2 Giant Cell Tumour of Bone and Giant Cell Reparative Granuloma 2.3 Bone Cysts 2.4 Osteoid Osteoma 2.5 Focal Proliferative Periosteal Processes 2.5.1 Florid Reactive Periostitis 2.5.2 Bizarre Parosteal Osteochondromatous Proliferation 2.5.3 Turret Exotosis 2.5.4 Subungual Exostosis 2.5.5 Periostitis Ossificans 2.6 Miscellaneous Benign Tumours 3 Malignant Bone Tumours of the Hand and Wrist 3.1 Chondrosarcoma 3.2 Osteosarcoma 3.3 Ewing sarcoma 3.4 Metastasis 3.5 Lymphoma 3.6 Multiple Myeloma 4 Conclusion 5 Keypoints References Tumor and Tumor-Like Lesions of Soft Tissue F. M. Vanhoenacker, P. Van Dyck, J. L. Gielen, and A. M. De Schep 1 Introduction 2 Benign Soft-Tissue Tumors 2.1 Synovial Cyst, Ganglion Cyst and Tendon Sheath Cyst 2.1.1 Definition and Nosological Classification 2.1.2 Clinical Findings 2.1.3 Imaging Findings 2.1.4 Conventional Radiography 2.1.5 Ultrasound 2.1.6 CT-Scan 2.1.7 MRI 2.2 Epidermoid Cyst 2.2.1 Definition and Histopathology 2.2.2 Imaging 2.3 Lipoma 2.3.2 Clinical Findings 2.3.3 Imaging 2.4 Lipomatosis of Nerve 2.4.2 Clinical Findings 2.5 Giant Cell Tumor of Tendon Sheath (GCTTS) 2.5.1 Definition 2.5.2 Clinical Findings 2.5.3 Imaging 2.6 Pigmented Villonodular Synovitis 2.6.1 Definition 2.6.2 Clinical Findings 2.6.3 Imaging Findings 2.7 Vascular Tumors and Lymphatic Tumors 2.7.1 Definition 2.7.2 Clinical Findings 2.7.3 Imaging 2.8 Benign Neurogenic Tumors 2.8.1 Definition 2.8.2 Clinical Findings 2.8.3 Imaging Findings 2.9 Glomus Tumor 2.9.1 Definition 2.9.2 Clinical Findings 2.10 Fibroma of the Tendon Sheath 2.10.1 Definition 2.10.2 Clinical Findings 2.10.3 Imaging Findings 2.11 Palmar Fibromatosis (Dupuytren Disease) 2.11.1 Definition 2.11.2 Clinical Features 2.11.3 Imaging Findings 2.12 Desmoid Tumors (Desmoid Type Fibromatosis) 2.12.2 Clinical Features 2.12.3 Imaging Findings 2.13 Synovial Chondromatosis 2.13.1 Definition 2.13.2 Clinical Findings 2.13.3 Imaging 2.14 Soft-Tissue Chondroma (Tenosynovial Chondromatosis) 2.14.1 Definition 2.14.2 Clinical Features 2.14.3 Imaging Features 3 Malignant Soft-Tissue Tumors 4 Pseudotumoral Lesions 4.1 Myositis Ossificans 4.2 Foreign-Body Granuloma 4.2.2 Clinical Findings 4.2.3 Imaging Findings 4.3 Rheumatoid Nodule 4.3.1 Definition 4.3.2 Clinical Findings 4.3.3 Imaging Findings 4.4 Gout, Tophaceous Pseudogout, and Other Metabolic Disease 4.5 Tenosynovitis and Soft-Tissue Abscess 4.6 Anomalous and Accessory Muscles 4.6.1 Definition 4.6.2 Clinical Findings 4.6.3 Imaging Findings 4.7 Anomalous Osseous Structures 4.8 B izarre Parosteal O steochondromatous P roliferation ( BPOP) 4.9 Knuckle Pads 4.10 Subcutaneous Granuloma Annulare 4.11 Hypothenar Hammer Syndrome 5 Conclusion 6 Key Points Miscellaneous Conditions with Manifestations in the Hand and Wrist Vikram S. Sandhu, A. Mark Davies, and Steven L. James 1 Introduction 2 Paget’s Disease 3 Sarcoid 4 Reflex Sympathetic Dystrophy 5 Haematological and Marrow Disorders 5.1 Haemophilia 5.2 Sickle Cell Disease 5.3 Thalassaemia 5.4 Other Marrow Disorders 6 Amyloidosis 7 Haemochromatosis 8 Phakomatoses 9 Macrodystrophia Lipomatosa 10 Hypertrophic Osteoarthropathy 11 Congenital Insensitivity to Pain 12 Toxic Agents and Pharmacological Agents 13 Radiation Changes 14 Massive Osteolysis 15 Key Points References Imaging the Post-Operative Wrist and Hand R. S. D. Campbell and D. A. Campbell 1 Introduction 2 Fracture Fixation 2.1 Indications 2.2 Implant Choice 2.2.1 Kirschner Wires 2.2.2 Internal Fixation Materials 2.2.3 External Fixation 2.3 Distal Radial Fractures 2.4 Scaphoid Fractures 2.5 Hamate Fractures 2.6 Other Carpal Bones 2.7 Metacarpal and Phalangeal Fractures 3 Prosthetic Joint Replacement 3.1 Indications 3.2 Implant Choice 3.2.1 Wrist 3.2.2 Hand 4 Arthrodesis 4.1 Indications 4.2 Implant Choice 4.2.1 Wrist 4.2.2 Hand 5 Osteotomy 5.1 Indications 5.2 Implants 6 Curettage and Bone Graft 6.1 Indications 6.2 Implant Choice 7 Tendon Repair 7.1 Indications 7.2 Implant Choice 8 Ligament Repair 8.1 Indications 8.2 Implant Choice 8.2.1 Wrist 8.2.2 Hand 9 TFCC Repair 9.1 Indications 9.2 Implant Choice References 10 Conclusions