Lee Justin C, Healy Jeremiah C
Department of Radiology, Chelsea and Westminster Hospital, London SW10 9NH, England.
Radiographics. 2005 Nov-Dec;25(6):1577-90. doi: 10.1148/rg.256055028.
The advent of ultra-high-frequency sonographic transducers has significantly enhanced our ability to image superficial structures. As a result, sonography now can be used to assess injuries of the tendons in the wrist and hand. A clear understanding of normal sonographic anatomy is required to prevent misdiagnosis and ensure optimal patient care. The anatomy of the wrist and hand is best described by considering the extensor and flexor surfaces separately. The carpal extensor retinaculum divides the dorsal extensor tendons into six separate synovial compartments, which are demarcated by the points of its attachment to the radius and ulna. The course of these tendons from the wrist to the sites of their insertion can be traced by using sonography. The intrinsic wrist ligaments, triangular fibrocartilage, and dorsal finger extensor hood also can be assessed sonographically. The anatomy of the flexor surface of the wrist is defined principally by the flexor retinaculum. The median nerve, which is located deep to the retinaculum in the carpal tunnel, and the ulnar nerve, which is superficial to the retinaculum in the Guyon canal, can be easily detected. The long flexor tendons in the wrist and hand are also clearly depicted at sonography. The flexor annular pulley system is formed by five foci of thickening along the long flexor finger tendon synovial sheath, and the second and fourth annular pulleys can be identified sonographically in most patients. Sonography provides a rapid, cheap, noninvasive, and dynamic method for examination of the soft-tissue structures of the wrist and hand. Familiarity with the appearance of normal anatomic structures is a prerequisite for reliable interpretation of the resultant sonograms.
超高频率超声换能器的出现显著提高了我们对浅表结构成像的能力。因此，超声检查现在可用于评估手腕和手部肌腱的损伤。为防止误诊并确保为患者提供最佳护理，需要清楚了解正常超声解剖结构。手腕和手部的解剖结构最好分别从伸肌面和屈肌面来描述。腕背侧支持带将背侧伸肌腱分成六个独立的滑膜腔，这些滑膜腔由其在桡骨和尺骨上的附着点划定界限。通过超声检查可以追踪这些肌腱从手腕到其附着部位的走行。手腕的固有韧带、三角纤维软骨和手指背侧伸肌帽也可以通过超声进行评估。手腕屈肌面的解剖结构主要由屈肌支持带确定。位于腕管内支持带深部的正中神经和位于Guyon管内支持带浅部的尺神经很容易被检测到。手腕和手部的长屈肌腱在超声检查中也能清晰显示。屈指环形滑车系统由沿屈指长肌腱滑膜鞘增厚的五个部位形成，在大多数患者中，超声检查可以识别第二和第四环形滑车。超声检查为检查手腕和手部的软组织结构提供了一种快速、廉价、无创且动态的方法。熟悉正常解剖结构的外观是可靠解读所得超声图像的先决条件。
