Ultrasound-Guided Wrist Injections

Michael N. Brown

Michael Gofeld

Background and indications: Wrist ultrasonography not only provides a means to evaluate anatomical structures of a joint and to facilitate injections but also helps to detect an active hyperemia associated with synovitis. Therefore, it may be a useful tool to monitor disease activity. That is why ultrasound is becoming more popular in rheumatologic practice. Ultrasound guidance improves accuracy of the radiocarpal injections. Ultrasound-guided contrast injection in radiocarpal magnetic resonance (MR) arthrograms has been shown to be a cost-effective method that spares unnecessary radiation exposure. It is also useful in evaluating fluid collection at the radiocarpal joint.

Anatomy: There are three proximal carpal bones that have imporTant joint function; they are the scaphoid, the lunate, and the triquetrum. The capsule communicates through the whole proximal joint as seen in Figure 65.1. The distal end of the radius is concave with articular facets contributing to the radiocarpal joint. This proximal concave surface of the joint is contiguous with the triangular fibrocartilage complex, which extends from the ulnar styloid to the distal radius. The distal surface of the joint is the articular surfaces of the scaphoid, the lunate, and the triquetrum. The capsule of the radiocarpal joint is attached to the distal radius and ulna and extends to the proximal carpal row. This joint is reinforced by extrinsic carpal ligaments.