Imaging of the hand and wrist

The history of imaging of the hand and wrist is the history of radiology itself. In December 1895, William Conrad Roentgen created the first radiograph of a human subject, that of his wife's hand. A few months later in February 1896, the first clinical application of x-rays in the United States revealed a Colles' fracture.(10) Diagnostic radiology has changed dramatically since that 20-minute exposure a century ago. Radiographic exposures are now measured in milliseconds, and the development of CT and MR imaging has aided greatly in the visualization of osseous and soft-tissue structures in multiple planes. This article reviews many of the modalities currently available for imaging the hand and wrist. By the very nature of their specialty, orthopedists take an active interest in imaging studies, often coming to their own conclusions regarding the interpretation of films without the assistance of a radiologist. For this reason, it is vital that the orthopedist know not only which study to request but how to assess whether the study is performed correctly. Much of the following material on imaging of the hand and wrist is based on the personal experience of the authors. Readers desiring a more complete discussion of the subject are directed to the encyclopedic text by Gilula and Yin entitled, Imaging of the Wrist and Hand.(15)