All rights are reserved by the Publisher, whether in whole or in part of the material, in particular the rights of translation, reprinting, re-use of illustrations, recitation, transmission, reproduction on microfilm or in any other physical way, and transmission or information storage. and retrieval, electronic adaptation, computer software, or similar or different methodologies known or developed hereafter. In the era of William Shakespeare, one of the greatest masters of the English language, the five human senses, namely vision, hearing, taste, smell and somatosensory sensation, were called external intelligence, while internal intelligence included common intelligence, imagination, fantasy, assessment. (recently referred to as instinct) and memory. Peter Vince Balint is Head of the 3rd Department of Rheumatology at the National Institute of Rheumatology and Physiotherapy in Budapest, an EULAR Center of Excellence in Imaging and Professor Honoris Causa at Semmelweis University in Budapest.
He is a reviewer of several international rheumatology journals in the field of sonography and is the editor of the imaging section of Hungarian Rheumatology. Peter Mandl is a private assistant professor and consultant at the Department of Rheumatology of the Medical University of Vienna, Austria, and a member of the EULAR Network of Imaging Research Centres. He has served as Chair of EMEUNET, an emerging EULAR network, is a previous member of the OMERACT Working Group on Ultrasound, a member of the EULAR Standing Committee of Musculoskeletal Imaging, Chair of the OMERACT Working Group on Cartilage Changes in Rheumatoid Arthritis and has coordinated or participated in several EULAR working groups (EULAR recommendations for the use of imaging in spondyloarthritis, EULAR points to consider when using ultrasound for healthcare professionals, etc.).
Florian Huber, MD Division of Neuro and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. Hannes Platzgummer, MD Division of Neuro and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Clinical Examination of the Hand and Wrist in Rheumatology
Anterior part of the third metacarpal (transverse head of the muscle) Bases of the second and third metacarpal bones, trapezius and capitate (oblique head of the muscle).
Imaging Anatomy: Conventional Radiography
When projecting one hand, the beam is focused on the head of the third metacarpal bone. The long axis of the arm and the lower part of the arm are aligned with the longitudinal axis of the cassette. The beam direction is vertical; the x-ray tube is positioned above the examination table.
The tube is directed to the central part of the detector at the height of the MCP joints. Requirements: The metacarpal and carpal bones and the distal ends of the radius and ulna are positioned [5]. The hook of the hamate, the scaphoid tuberosity, and the trapezius should form the palmar surface.
MRI of the hand in arthritis requires documentation of both hands (Fig. 4.1) [13]. Areas of research include the hand as a whole, the wrist (sometimes including the metacarpal) and specific imaging of the thumb or groups of fingers. High-resolution peripheral quantitative computed tomography (HRpqCT) is a technique for analyzing bone architecture at the distal radius, wrist, and distal tibia.
The proximal boundaries of the ulnocarpal compartment are the ulnar styloid and the joint capsule. If an anatomical dissection of the TFCC is performed, it is difficult to separate. In the ulnocarpal compartment the tendon sheath of the extensor carpi ulnaris tendon and the small space around the meniscus homolog of the TFCC (Fig. 4.2).
The superficial aspect of the growth plate, during childhood and adolescence, can be considered as the fourth example. Shallow undulating grooves on the radial aspect of the scaphoid (small arrows) represent insertions of unresolved mucosal folds. Examining the validity of the magnetic resonance imaging score of rheumatoid arthritis according to the OMERACT filter - a systematic review of the literature.
In vivo 7.0-tesla magnetic resonance imaging of the wrist and hand: technical aspects and applications. Curvature characteristics and compliance of the carpometacarpal joint of the thumb: differences between female and male joints.
Sonographic Terminology
c) transducer position for the longitudinal scan; (d) Ultrasound of the longitudinal scan. ed extensor digitorum tendons, edm extensor digiti minimi, pin posterior interosseous nerve, tri triquetrum, u ulna, Di distal, Pr proximal, Ra radial, Ul ulnar. (c) transducer position for the transverse scan; (d) ultrasound of the transverse scan. et extensor tendon, mc metacarpal, pp proximal phalanx, Pr proximal, Di distal, Ra radial, Ul ulnar. (c) transducer position for the transverse scan; (d) ultrasound of the transverse scan. dp distal phalanx, et extensor tendon, mp middle phalanx, nb nail bed, nm nail matrix, Pr proximal, Di distal, Ra radial, Ul ulnar.
Sonopathology: Pathological Findings (Articular and Periarticular)
Several studies have recommended scanning only certain aspects of the small joints of the hand. Tendinitis of the extensor digitorum tendon as indicated by decreased echogenicity of the tendon (asterisk) accompanied by intratendinous force Doppler signal (arrowheads). Tenosynovitis of the flexor tendons (asterisk) accompanied by nodular thickening and hypervascularization of the A1 pulley in the trigger finger (arrowhead).
The arrows indicate a fibrous rheumatoid pannus within a bony erosion of the lateral aspect of the metacarpal head. The power Doppler signal shows that inflamed pannus invades the lateral aspect of the metacarpal head in rheumatoid arthritis. Tenosynovitis of the finger flexor tendons (arrowhead). et finger extensor tendon, ft finger flexor tendon, mp middle phalanx, pp proximal phalanx, Di distal, Pr proximal.
The arrowheads indicate tophasic deposits that impair visualization of the finger extensor tendon. The arrowheads indicate pyrophosphate deposits compressing the median nerve which appears swollen in the proximal part of the carpal tunnel. A focal thinning of the median nerve (notch sign) is also a morphologic change that indicates a secondary cause of CTS.
Ultrasound of the hand and wrist can also be used to evaluate connective tissue diseases. Ultrasound examination of the hand in patients with systemic lupus erythematosus (SLE) also revealed a high prevalence of findings, although the number of abnormalities was highly variable [44]. Periarticular edema, marked thickening of the periarticular subcutaneous tissue (arrows) in remitting seronegative symmetric synovitis with pitting edema (RS3PE) syndrome.
Subluxation of the proximal phalangeal base relative to the metacarpal head in Jaccoud arthropathy. Ultrasound of synovitis in rheumatoid arthritis: advantages of dorsal over palmar approach to finger joints.
