Ultrasound in Wrist and Hand Sport Injuries

Hand and wrist injuries are common in athletes and can affect articular structures (ligaments, joint surfaces etc), periarticular tendons, muscles and nerves. These injuries can be acute or chronic. Acute injuries follow sudden traumatic events such as falls or joint sprains. Chronic lesions can be the result of local repetitive microtrauma or the sequelae of an acute injury. An accurate patient history and careful clinical examination are essential to obtain an early diagnosis. This allows prompt and proper treatment, assisting the athlete to return to sport without significant complication or delay. Nevertheless, an imaging modality is usually obtained to confirm the clinical suspicion, assess the extent of tissue damage and help choose between surgical or conservative treatment. Ultrasound (US) is a cheap, non-invasive and dynamic modality that allows accurate evaluation of the para-articular soft tissues of the wrist and hand. It is readily available and patient friendly. However, it requires an experienced physician with high quality equipment and accurate knowledge of normal anatomy and anatomic variants and ability to correlate with clinical data1-3. Before starting the US examination, physicians should carefully review the request form, as well as obtain a brief history and perform a basic physical examination in order to help target the region of interest. Standard radiographs obtained before the US examination are helpful since the radiographs allow a panoramic evaluation of the bone and joint structures that are not evaluated as effectively with US. The two imaging modalities are complementary and work well in daily practice when an immediate or prompt imaging assessment is needed. Modern US equipment with broadband electronic transducers working at 10 to 17 MHz is necessary for accurate study of the superficial soft tissues of the wrist and hand. Hockey stick transducers are particularly helpful since their small size allows dynamic examination during movement of joints and tendons. Colour Doppler is always performed to detect signs of local inflammation or to judge the flow of internal vessels. Also, evaluation of the contralateral limb can be performed if needed, for comparison. This article briefly presents the US appearance of the most frequent sport injuries of the hand and wrist.