Best Practice Case Studies-Case 159 Asset 2 Imaging Hand and Wrist Injuries

Pdf Summary

This Radiology review summarizes the most common sports-related injuries of the hand and wrist and emphasizes the role of imaging in diagnosis and treatment planning. Injuries are grouped into acute traumatic lesions and overuse injuries.<br /><br />Acute wrist injuries most often involve fractures of the scaphoid, hook of the hamate, and ulnar styloid. Scaphoid fractures are common after a fall on an outstretched hand and can be occult on initial radiographs; CT or MRI is often recommended when suspicion remains high. Hamate hook fractures occur in sports such as golf, baseball, and racket sports and are frequently missed without specialized views. Ligament injuries, especially of the scapholunate ligament and lunotriquetral ligament, are important because they can lead to progressive carpal instability and arthritis if not recognized. CT arthrography and MR arthrography are often more sensitive than conventional MRI for these tears.<br /><br />The triangular fibrocartilage complex (TFCC) is another key structure in ulnar-sided wrist pain. Traumatic TFCC tears are classified by location and may or may not produce distal radioulnar joint instability. Imaging helps distinguish peripheral foveal tears, which often require reconstruction, from central tears or degenerative lesions.<br /><br />Overuse injuries are usually caused by repetitive wrist rotation, deviation, extension, or forceful gripping. Common examples include De Quervain tenosynovitis, intersection syndrome, extensor carpi ulnaris tendinopathy or subluxation, flexor carpi ulnaris tendinopathy, and various impaction syndromes such as ulnocarpal and ulnar styloid impaction. Other repetitive stress injuries include stress fractures, gymnast’s wrist, Kienböck disease, carpal boss, carpal tunnel syndrome, Guyon canal syndrome, and hypothenar hammer syndrome.<br /><br />Finger and thumb injuries are also reviewed, including mallet finger, boutonniere injury, boxer’s knuckle, jersey finger, flexor pulley tears, Bennett fracture, and skier’s thumb. Ultrasound, MRI, CT, and radiographs each have specific strengths depending on the injury. Overall, the article stresses that accurate imaging is essential to avoid missed injuries and long-term functional impairment.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 159

Topic Wrist

Keywords

4th Edition

sports-related hand injuries

wrist fractures

scaphoid fracture

hook of hamate fracture

scapholunate ligament injury

triangular fibrocartilage complex

De Quervain tenosynovitis

ulnocarpal impaction syndrome

mallet finger

Bennett fracture

4th Edition, Case 159

Wrist