II. Images

III. Preparation

  1. Consider using acoustic stand-off pad on Ultrasound probe (or excessive Ultrasound gel)
  2. Linear Ultrasound probe

IV. Technique: Dorsal Wrist

  1. Positioning
    1. Forearm pronated (palm down, thumb medial)
    2. Wrist and hand propped on towel
  2. View 1: Extensor (dorsal) compartments 1-3 in Short Axis (SAX)
    1. Ultrasound probe
      1. Probe indicator towards radial aspect of wrist (radius at left screen)
      2. Slide towards radial aspect to view the first dorsal compartment after identifying Lister's Tubercle
    2. Images
      1. usWrist_DorsumHomeLister.png
    3. Components
      1. Extensor compartment 1 (lateral aspect of radius near snuff box)
        1. Abductor Pollicis Longus (APL)
        2. Extensor Pollicis Brevis (EPB)
      2. Extensor compartment 2 (dorsal aspect of radius)
        1. Extensor Carpi Radialis Longus (ECRL)
        2. Extensor Carpi Radialis Brevis (ECRB)
      3. Lister's Tubercle
      4. Extensor Compartment 3
        1. Extensor Pollicis Longus
  3. View 2: First Carpometacarpal Joint at dorsolateral wrist in long axis (LAX)
    1. Ultrasound probe
      1. Probe in long axis, with indicator towards proximal arm and elbow
      2. Start with probe over distal radius and slide distally as Scaphoid, Trapezium and First Metacarpal come into view
    2. Images
      1. usWrist_RadialCMC1.png
    3. Components (from screen left to right)
      1. Distal Radius
      2. Scaphoid
      3. Trapezium
      4. First carpometacarpal joint (CMC-1)
        1. May be used to direct needle for CMC-1 Injection
      5. First Metacarpal
    4. Additional views: De Quervains Tenosynovitis
      1. Slide probe over the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) in long axis
      2. Probe may be rotated 90 degrees to view the APL and EPB in short axis
  4. View 3: Dorsal-medial wrist (ulnar wrist and TFCC)
    1. Positioning and Ultrasound probe
      1. Probe in long axis, with indicator towards proximal arm and elbow
      2. Patient radially deviates the wrist to open the ulnar aspect of the wrist
    2. Images
      1. usWrist_UlnarTFCC.png
    3. Components
      1. Distal Ulna
      2. Triangular Fibrocartilage Complex (TFCC)
        1. Represents only the TFCC homologue (most superficial aspect, most remains hidden within joint)
      3. Lunate (deep to TFCC)
      4. Triquetrum

V. Technique: Volar Aspect

VI. References

  1. Moore (2016) GCUS Musculoskeletal Ultrasound Course, St. Pete's Beach, FL
  2. Moore (2013) Upper Extremity Ultrasound Video, Gulf Coast Ultrasound

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