Normal MR imaging findings of the midhand and fingers with anatomic correlation

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Abstract

In the present article, we correlate MR imaging studies of cadavers, volunteers and patients with cadaveric dissection and sectioning. First anatomy at wrist level is discussed. In a next section, we address the midhand with the flexor and extensor tendons, and interosseous and lumbricalis muscles. The dorsal hood at the level of the metacarpophalangeal joint is also addressed. An overview of the anatomy of the thenar is provided. Finally, the flexor system of the fingers with pulleys and volar plates, as well as the central and distal insertion of the finger extensor tendons is discussed.

Introduction

Wrist and hand anatomy has been described in several articles. Initial MR and US imaging studies focused on the carpal tunnel structures and triangular fibrocartilage complex. With the advent of the newest technology both in MR and US, sufficient imaging detail is available to assess the fine structures of midhand and hand [1], [2], [3], [4]. The soft tissue component of many “classic” bone injuries that could be seen on radiographs, such as the volar plate “bony” avulsion, can now be assessed. In addition, previously when a bony component was absent, such as in volar plate injury, imaging diagnosis was impossible. In this article, we systematically address the imaging anatomy of the wrist, midhand (dorsal side and ventral side), the thenar and the fingers (dorsal and ventral aspect). We provide an overview of findings in studies of cadavers, volunteers and patients.

Section snippets

Technical considerations

Routine MR systems now usually offer a dedicated wrist coil. This coil can be employed for hand imaging and allows comfortable positioning for the patient. The patient can be placed in supine position with the hand next to the body. Image quality is diminished, however, since the hand is not placed in the center of the magnet. With small field of view surface coils, image quality can be improved because the hand can be placed in the center of the magnet. Positioning is very uncomfortable,

Wrist level

On a transverse section obtained at wrist level, on the palmar side, three tendons have a more superficial location. At the ulnar side, the flexor carpi ulnaris tendon is evident. This tendon inserts on the pisiform bone. The pisiform bone is an excellent landmark to depict the location of the ulnar nerve in Guyon's canal. On the radial side of the wrist, the flexor carpi radialis is evident. This tendon inserts on distal carpal bones and on the base of the fourth and fifth metacarpal bones.

References (9)

  • J.A. Clavero et al.

    MR imaging of ligament and tendon injuries of the fingers

    Radiographics

    (2002 March–April)
  • S. Bianchi et al.

    High-frequency ultrasound examination of the wrist and hand

    Skeletal Radiol

    (1999 March)
  • G. Moschilla et al.

    Sonography of the finger

    AJR Am J Roentgenol

    (2002 June)
  • J.L. Drapé et al.

    Closed ruptures of the flexor digitorum tendons: MRI evaluation

    Skeletal Radiol

    (1998)
There are more references available in the full text version of this article.

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