Flexor wrist

[Eve Skaros]

Hi Steve!

What other things besides looking for synovial
fluid would you need to assess when looking at the flexor part of the wrist?

Thankyou

[Stephen Bird]

Hi Eve,

So many things!

Certainly flexor sheath synovitis is a common pathology and may manifest itself as free fluid or just some synovial thickening with no free fluid. I use sensitive low flow Doppler like SMI to assess the synovial sheaths for vascularity and if any is identified it is indicative of synovitis. There are 2 flexor sheaths. The first one is called the ulnar bursa and is a combined flexor sheath for the four FDS and four FDP tendons. The other is the radial bursa and it takes care of only the FPL tendon.
On the flexor side I also look for other space ocupying lesions in the carpal tunnel and these can include a ganglion, volar carpus arthritis, lipoma, nerve sheath tumour etc.
You can do detailed assessment of the median and ulnar nerve using the techniques I outline in the fundamentals of wrist ultrasound presentation. Included in the euro assessment I would look at the thenar muscle group for atrophy patterns that I describe in the “Assessment of the theta eminence” webinar. This is a fabulous way of assessing motor nerve function to the hand.
Then you have the STT joint and the FRC tendon which suffers from a combination of arthritis followed by synovitis, followed by FRC tenosynovitis and eventual FCR rupture.
The FCU tendon is generally well behaved, however you may occasionally see hydroxyapatite arising from the pisiform bone affecting the FCR tendon.
The pisotriquetral joint can also be assessed for arthritis and synovitis.
All of this is covered in the fundamentals of wrist ultrasound presentation as well as a few other advanced wrist ultrasound recordings on the website.
Please enjoy them.
Feel free to follow up with further questions.
Happy scanning,

Steve.

[Author]

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