Hand and wrist pathologies are common in clinical practice, often presenting with pain, restricted motion, or swelling. Radiology plays a crucial role in early diagnosis, staging, and management. Among these, Kienböck’s disease (avascular necrosis of the lunate) is a classic example where imaging directly impacts treatment decisions.
📌 Key Hand & Wrist Pathologies on Imaging
1. Kienböck’s Disease (Avascular Necrosis of Lunate)
- X-ray findings (early stages may be normal):
- Increased sclerosis of lunate.
- Later → fragmentation, collapse, carpal collapse.
- MRI (modality of choice):
- Low signal on T1.
- Variable T2 (early edema = high signal; chronic necrosis = low signal).
- Best for early detection before X-ray changes.
- CT: Useful for collapse and fracture lines.
2. Scaphoid Fracture & Avascular Necrosis
- X-ray: May miss occult fracture.
- MRI: Gold standard for occult fractures. Shows marrow edema and fracture line.
- CT: Best for cortical detail and union assessment.
- AVN of scaphoid (Preiser’s disease): low T1, variable T2 signal in proximal fragment.
3. Carpal Instabilities (e.g., SLAC wrist, VISI, DISI)
- X-ray: Widening of scapholunate interval (“Terry Thomas sign”), abnormal carpal angles.
- MRI: Assesses ligament tears and cartilage.
- CT/CT arthrography: High-resolution bone and joint surface evaluation.
4. Inflammatory Arthritis (e.g., Rheumatoid, Psoriatic)
- X-ray: Joint space narrowing, erosions, periarticular osteopenia.
- MRI: Detects early synovitis, pannus, and erosions.
- US: Detects synovial hypertrophy, power Doppler for activity.
5. Ganglion Cyst
- US: Well-defined cystic lesion, anechoic or hypoechoic.
- MRI: Well-circumscribed fluid-signal lesion, often adjacent to joint capsule or tendon sheath.
6. Tenosynovitis
- US: Thickened tendon sheath with fluid.
- MRI: Fluid around tendon, sheath thickening, enhancement post-contrast.
📍 Teaching Pearls
- MRI is the most sensitive modality for early detection of hand & wrist pathologies (e.g., AVN, occult fractures, arthritis).
- X-rays remain first-line for fractures, alignment, and chronic changes.
- US is valuable for cystic lesions and tendon evaluation.
