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MSK ultrasound > Wrist Anatomy and Pathology > Flashcards

Wrist Anatomy and Pathology Flashcards

1
Q

What carpal bones makes up the radiocarpal joint?

A

Radius + Scaphoid and Lunate

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2
Q

What carpal bones makes up the ulnocarpal joint?

A

Ulna + Lunate and Triquetrium

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3
Q

What is the attachment site for Lister’s Tubercle?

A

Dorsal radial tubercle

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4
Q

What “processes” are landmarks for compartment 1 and compartment 6 of the wrist?

A

1 - Radial styloid

6- Ulnar styloid

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5
Q

What carpal bone is embedded in a tendon and is not involved in wrist movement?

A

Pisiform

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6
Q

What tendons are in compartment 1?

A

APL & EPB

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7
Q

What tendons are in compartment 2?

A

ECRL & ECRB

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8
Q

What tendons are in compartment 3?

A

EPL

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9
Q

What tendons are in compartment 4?

A

ED (digitorum) is more superficial & EI (indices) is more deep

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10
Q

What tendons are in compartment 5?

A

EDM (digiti minimi)

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11
Q

What tendons are in compartment 6?

A

ECU

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12
Q

What two compartments are connected to the thumb?

A

1 and 3 - hint: they both have “pollicis” in their names

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13
Q

What compartments lie on the radius and what ones lie on the ulna?

A

Radius - 1-4

Ulna - 5-6

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14
Q

Tendons from which compartment (s) are affected in De Quervain’s tenosynovitis?

A

1 - thumb side

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15
Q

What tendons form the lateral aspect of the “snuff box” ?

A

Compartment 1 - APL & EPB

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16
Q

What tendon(s) form the medial aspect of the “snuff box” ?

A

Compartment 3 - EPL

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17
Q

What tendon commonly ruptures in patients w/ rheumatoid arthritis due to it’s sharp radial deviation around Lister’s tubercle?

A

EPL

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18
Q

The crossing of what tendons creates “intersection syndrome”? (hint: theres 2)

A

EPL (compartment 3) over the ECRL and ECRB
AND APL & EPB (compartment 1) over ECRL and ECRB

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19
Q

What two compartments are most
commonly affected by tenosynovitis of the wrist?

A

5 and 6

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20
Q

What nerve is affected in carpal tunnel?

A

Median nerve at the wrist - landmarks = pisiform and scaphoid bones

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21
Q

What nerve is affected in Guyon tunnel/cyclists finger?

A

Ulnar nerve at the wrist - beside ulnar artery and pisiform bone

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22
Q

The flexor retinaculum of the wrist forms the roof. What bones does it attach to on the radial aspect and what bones does it attach to on the ulnar side?

A

Radial side = scaphoid and trapezium

Ulnar side = pisiform and hamate

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23
Q

Cyclists finger is also known as ?

A

Guyon tunnel - site for ulnar nerve compression in long distance cyclists

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24
Q

What landmarks do we see on ultrasound in Guyon tunnel?

A

Ulnar artery, pisiform (proximally) and hamate (distally)

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25
Q

How to decipher between joint effusion vs synovial hypertrophy/synovitis?

A

Joint effusions will be anechoic to hypoechoic, will be compressible, won’t light up with colour, may contain swirling of echoes

Synovial hypertrophy may be hypoechoic, will have colour flow internally, and will NOT compress with transducer pressure

26
Q

Synovitis of the dorsal wrist will have what kind of appearance on ultrasound?

A

Hypoechoic marbles that light up - slide 8

27
Q

On ultrasound, you see hypoechoic round “marble” looking pathology that has colour flow on the dorsal wrist, what is the most likely diagnosis?

A

Synovitis

28
Q

What pathology should you look for if you suspect bony erosions?

A

Synovitis

29
Q

What pathology of the wrist leads to pain, numbness and weakness in the associated area of the hand?

A

Nerve pinching/compression

30
Q

What pathology is the most common entrapment syndrome of the upper limb?

A

Carpal tunnel syndrome - compression of median nerve

31
Q

What is the most common CAUSE of carpal tunnel syndrome specifically?

a) Ganglion cysts
b) Solid masses
c) Tenosynovitis of flexor tendons
d) Tenosynovitis of extensor tendons

A

C - tenosynovitis of flexor tendons

32
Q

SF of carpal tunnel?

A
  1. Thickened median nerve by 3x - hypoechoic
  2. Loss of “honeycomb” nerve appearance
33
Q

Measuring carpal tunnel includes length from pisiform to scaphoid and then directly superior to the retinaculum. What is the abnormal measurement to the retinaculum?

A

> 4mm

34
Q

What are the carpal tunnel measurements?

Normal
Boderline
Abnormal

A

Normal <9mm

Borderline 9-12mm

Abnormal >12mm

35
Q

T or F? A bifid median nerve increases the likelihood of carpal tunnel syndrome?

A

TRUE

36
Q

Patient presents with parasthesia of the last 2 digits (ring finger and pinky). What is the most likely diagnosis?

A

Guyon tunnel - compression of the ULNAR nerve AKA “cyclists finger”

37
Q

What is the most common cause of Guyon Tunnel AKA cyclists finger?

A

Trauma - falling

38
Q

What pathology involves the immune system attacking the tendon sheaths in the wrist & causing inflammation of synovial lining of tendons?

A

Rheumatoid tenosynovitis

39
Q

What is the main SF of rheumatoid tenosynovitis?

A

“Pannus” = hypoechoic with fluid in sheath - has colour flow

40
Q

What tendon in what compartment is most commonly affected by rheumatoid tenosynovitis?

A

Extensor carpi ulnaris - compartment 6

41
Q

What pathology includes large amounts of fluid around the tendons causing symptoms similar to gout?

A

Tenosynovitis

42
Q

What is the most common tendinopathy of the wrist?

A

De Quervains Tenosynovitis - affects compartment 1 tendons of the wrist

43
Q

What is another name for De Quervains Tenosynovitis?

A

Stenosing tenosynovitis

44
Q

What is the most common tendon of the wrist to tear?

A

Flexor digitorum profundis

45
Q

What are the most commonly affected EXTENSOR tendons in terms of tears?

A

EPL - compartment 3 - bends around listers tubercle

EDM - compartment 5 - bends around ulnar styloid

46
Q

What extensor tendon is the most prone to subluxation?

A

Extensor carpi ulnaris = compartment 6

47
Q

“Boxer knuckle” is AKA?

A

Extensor tendon subluxation

48
Q

What is Gamekeeper’s or skier’s thumb?

A

Injury to the ulnar collateral ligament (UCL)- on the medial aspect of the dorsal thumb

49
Q

Stener lesion is when the ligament is retracted proximally, this lesion is seen in what pathology?

A

Gamekeeper’s or skier’s thumb

50
Q

Skier’s thumb is due to what action?

a) Acute hyperabduction
b) Chronic hyperabduction
c) Acute hypoabduction
d) Chronic hypoabduction

A

Acute HYPER-abduction

51
Q

Stenosis tenosynovitis of the A1 pulley is also known as?

A

Trigger Finger

52
Q

What is the most common expansible lesion of the wrist?

A

Ganglia

53
Q

Dorsal ganglia most commonly arises from what ligament?

A

Scapho-lunate

54
Q

T or F? Palmar ganglia is ALWAYS found on the ulnar aspect of the wrist?

A

FALSE - always found on the RADIAL side

55
Q

Palmar ganglia often arises from what joint?

A

Radioscaphoid

56
Q

What type of ganglion causes pain due to compression on the radial nerve?

A

Dorsal occult ganglion

57
Q

What is the 2nd most common mass of the wrist/ hand?

A

Giant cell tumor of tendon sheath (GCTTS)

58
Q

Where is extensor indices in relation to extensor digitorum in the dorsal wrist?

A) Medial
B) Lateral
C) Superficial
D) Deep

A

D) deep

59
Q

Where is the hook of hamate in relation to the ulnar nerve?

A) Anterior
B) Posterior
C) Medial
D) Lateral

A

Posterior

60
Q

What are the three wrist recesses?

A
  1. Radio-carpal joint
  2. Mid-carpal joint
  3. Distal radio-ulnar joint

MSK ultrasound (9 decks)

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