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