Anatomy and imaging of wrist joint (MRI AND XRAY)

Anatomy and imaging of wrist joint (xray and MRI).
this ppt was made as the class presentation by Kajal Jha as the part of the course of BSC MIT at BPKIHS,Dharan . It covers the part of syllabus of third year of BSC MIT of this institution.

1. Anatomy and Imaging of Wrist Joint Presentor: Ms Kajal Jha Mr Krishna Sarraf Mr Neeraj Kr Chaudhary Mr Prabin Dhaurali Moderator: Mr Ranjit Jha Dpt. of Radiodiagnosis and Imaging Assistant Professor

2. What is it? Joint At the junction of the hand and the forearm Synovial, ellipsoid and biaxial

3. Also known as RADICARPAL joint

4. Wrist is the junctional zone between the hand and the forearm . The anatomical name is CARPUS. Eight carpal bones arranged in two rows as skeletal foundation.

5. Bones taking part?? Lower end of radius Presents the triangular area laterally for scaphoid Presents the quadrilateral area for the lunate medially .

6. Triangular articular disc Triangular in shape Apex attached to the styloid process of the ulna. Base attached to the lower end of the radius at the lower limit of the ulnar notch of the radius. Is continuous with the synovial membrane of the inferior radioulnar joint.

7. PISIFORM does not play role in the radiocarpal joint .It is a sesamoid bone acting as a pulley for flexor carpi ulnaris .

8. Distal articular surface- Convex articular surface Extends more downwards and posteriorly than anteriorly . Scaphoid,lunate and the triquetral bones from lateral to medial side. Proximal articular surface-concave

9. Synovial membrane It covers the capsule from inside and other structures except the articular areas. It is continuous with synovial membrane of the inferior radioulnar joint where the articular disc has an opening.

10. ligaments Anterior radiocarpal Posterior radiocarpal Radial collateral The ulnar collateral The radial and ulnar collateral ligaments are attached to the styloid processes of the radius and ulna respectively.

11. Blood supply Anterior and posterior carpal arches.

12. Nerve supply Anterior and posterior interosseous nerves Posterior carpel arches.

13. movements Flexion Extension Abduction Adduction and circumduction

14. Extension is more powerful than flexion. Flexion appears greater than extension due to the movement of mid carpel joints. Firm grip of hand is possible when wrist is dorsiflexed ( eg : knife helding )

15. Flexors: Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Extensors Extensor carpi radialis longus Extensor carpi radialis brevis Abductor pollicic longus and extensor pollicis brevis Adductors Extensor carpi ulnaris Flexor carpi ulnaris

16. Where are they? Muscles in front are called flexors Muscles at behind are called extensors Muscles on the medial side of wrist are ulnar deviators Muscles on the radial side of wrist are abdutors COMBINATION of all movement leads to ROTATION .

17. Relations

18. Imaging Modalities X-ray CT Scan MRI MR Arthrography

19. Standard radiographic evaluation of the wrist. The routine radiographic evaluation includes (from left to right) posteroanterior , lateral, and oblique radiographs.

20. Carpal tunnel syndrome  (CTS) a medical condition due to compression of the median nerve as it travels through the wrist at the  carpal tunnel . The main symptoms are pain, numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring fingers. Causes:  Compression of the median nerve at t... Symptoms:  Pain ,  numbness , tingling in the thu ... Treatment:  Wrist splint , corticosteroid injections, ... Risk factors:  Genetics ,  obesity , repetitive wrist 

21. Carpal tunnel view Hyperextension of the hand and the central ray is directed along the volar aspect at an angle of 25 to 30°.

22. Carpal tunnel view Hyperextension of the hand and the central ray is directed along the volar aspect at an angle of 25 to 30°.

23. MRI an  MRI shows  the soft tissues as well as the bones, it is particularly useful for diagnosing injuries to the cartilage, tendons and ligaments, as well as areas of swelling. The test is accurate in determining the severity of carpal tunnel syndrome.

24. MRI protocol Indication- Evaluation of the patients with suspected carpal tunnel syndrome. Tendon tears Tenosynovitis Arthritis Pain and inability arising due to ligamentous or osteochondral injury.

25. Patient Positioning Supine with head first Arms beside the chest with the forearm in pronation or neutral position Fingers relaxed in extension No Contrast is used.

26. PULSE SEQUENCES T1 CSE in axial, coronal and sagittal plane. Coronal plane refers to the long axis of the triangular fibrocartilage. STIR or T2 FSE with fat suppression in the axial, coronal and sagittal plane. 3D FSPGR with fat suppression

27. Slice thickness- 2-3 mm Slice interval 0.05mm

28. Scan range Axial Plane From the superior limit of the inferior radioulnar joint to the bases of the metacarpals. Coronal Plane From the anterior to the posterior aspect of the wrist joint including the carpel rows and the inferior radioulnar joint . Sagittal plane From lateral to the medial aspect of the wrist.

29. Points to ponder To obtain the anatomic symmetry of both the upper extremities, both the hands are scanned in the same FOV in a large diameter coil. Tapes, foams or rubber padding can be used to keep the limb in relaxed position for optimal image quality. An optimal position results when the long axis of the radius is in the line with the central metacarpal axis. Coronal plane sequence should be planned on the sagittal localizer to get the standard plane.

30.  On axial images, the dorsal component is a thick, band-like structure with low signal intensity, whereas the volar component is heterogeneous (Figure of next slide). The proximal zone is best seen on coronal images. Although the proximal component of the SLL has a relatively similar triangular shape, it has a wide variety in shape.

31. The intrinsic ligaments on coronal PDWI. The proximal zones of the SLL and LTL show triangular shapes. Arrows show the ulnotriquetral ligament.

32. References BD Chaurasiya Human Anatomy Volume 2 Berry Diagnostic radiology Musculoskeletal and Breast Imaging-2 nd Edition. CT and MRI Protocol – a practical approach, 3 rd edition. Kadasne’s Textbook of Anatomy-Upper and lower extremities Mollers atlas of crossectional anatomy – spine ,extremities and joint. Musculoskeletal MRI-Wrist

33. THANK YOU