wrist MRI

MRI of the wrist is a fairly frequent examination in musculoskeletal radiology practice and not quite as common in general radiological practice. This approach is an example of how to create a radiological report of an MRI of the wrist knee with coverage of the most common anatomical sites of possible pathology, within the wrist.

Systematic review

A systematic review in the MRI of the wrist is essential since wrist anatomy itself is a complex entity with small structures, pathologies and injury patterns are manifold and involve a whole lot of different therapeutical approaches.

Bones

The bony structures of the wrist, the pictured distal radius and ulna to the bases and proximal parts of the metacarpals are assessed including the proximal and distal row of carpal bones.

• fractures, dislocations, erosions
• scapholunate advanced collapse (SLAC)
• scaphoid nonunion advanced collapse (SNAC)

Joint space and capsule

Assessment of the following structures:

• joint space
  • joint effusion if present and possible intra-articular fragments or loose bodies
• synovia
  • synovial thickening and hyperenhancement and other abnormalities
  • rheumatoid arthritis

Radiocarpal articulation and midcarpus

Assessment of the following structures and their alignment:

• proximal carpal row: scaphoid, lunate, triquetrum (pisiform)
• distal carpal row: trapezium, trapezoid capitate and hamate bones
• variant anatomy: lunate type, carpal boss

Extrinsic carpal ligaments

• palmar radiocarpal ligaments
• dorsal radiocarpal ligaments

Intrinsic carpal ligaments

• proximal interosseous ligaments:  scapholunate (SL), lunotriquetral ligament (LT)
• midcarpal ligaments
• distal carpal interosseous ligaments
  • carpal instability
  • scapholunate dissociation
  • dorsal-intercalated-segment instability (DISI) 
  • volar-(palmar)-intercalated-segment instability (VISI)
  • wrist ganglion

Ulnocarpal articulation and distal radioulnar joint (DRUJ)

Assessment of the following structures:

• triangular fibrocartilage complex (TFCC)
• ulnocarpal ligaments: ulnolunate ligament, ulnotriquetral ligament
• lunotriquetral ligament (LT)
• distal radioulnar joint (DRUJ)
  • ulnar impaction syndrome
  • triangular fibrocartilaginous complex (TFCC) injuries
  • ulnar impingement syndrome

Extensor compartments and tendons

Assessment of the following structures:

• Extensor compartments of the wrist
  • tenosynovitis, tears
  • De Quervain tenosynovitis 
  • intersection syndrome, distal intersection syndrome
  • extensor carpi ulnaris tendinopathy
• Variant anatomy: extensor digitorum brevis manus

Thenar soft tissues, carpal tunnel and flexor tendons

Assessment of the following structures:

• flexor carpi radialis tendon
  • tenosynovitis
• radial and ulnar palmar bursae
• flexor digitorum profundus, flexor digitorum superficialis and flexor pollicis longus tendons
  • tenosynovitis, bursitis, rice bodies, PVNS, GCTTS
• median nerve
• flexor retinaculum (transverse carpal ligament)
  • Variant anatomy: bifid median nerve, persistent median artery
  • carpal tunnel syndrome
• thenar muscles

Hypothenar soft tissues, Guyon’s canal

• flexor carpi ulnaris tendon
  • tenosynovitis
• pisiform bone 
  • pisiform fracture
• Guyon’s canal: superficial/deep ulnar nerve, ulnar artery
• hypothenar muscles
• Variant anatomy: anomalous muscles
  • Guyon’s canal syndrome, ganglion cysts, lipoma, PNST, hypothenar hammer syndrome

Common pathology

• scaphoid fracture
• scapholunate dissociation
• carpal instability
• triangular fibrocartilage complex (TFCC) injury
• ulnar-sided wrist impaction and impingement syndromes
• De Quervain tenosynovitis 
• intersection syndrome, distal intersection syndrome
• carpal tunnel syndrome
• Guyon’s canal syndrome

See also

• wrist ligaments
• triangular fibrocartilage complex (TFCC)