MRI wrist provides detailed images of the skeleton, ligaments and tendons

The wrist is an anatomically complex joint that consists of eight small carpal bones together with the radius and ulna of the forearm. Between the bones are several small joints and ligaments that together give the wrist stability while allowing a large range of motion. A large number of tendons, nerves and blood vessels also pass through the area.

Pain or impaired function in the wrist can therefore be due to many different structures and it is not always possible to determine the cause solely through symptoms and clinical examination. Magnetic resonance imaging, MRI, can provide detailed images of both the skeleton and soft tissues and is particularly valuable for assessing ligaments, TFCC, tendons, bone marrow, cartilage and other soft tissue structures.

MRI wrist is often used when the symptoms have persisted for a long time, when an injury has not healed as expected or when previous X-ray examinations have not been able to explain the symptoms. The examination uses magnetic fields and radio waves and does not involve ionizing radiation.

When can an MRI of the wrist be relevant?

Which imaging examination is most appropriate depends on the symptoms and the suspected injury. In acute trauma or long-term wrist pain, plain X-rays are often used as a first step to assess the skeleton. If the X-ray is normal or does not provide sufficient information, MRI can be an important next step.

MRI of the wrist may be relevant in, among other things:

• persistent or recurrent wrist pain where the cause has not been determined.
• pain after a fall, twist or other injury when the X-ray does not explain the symptoms.
• suspected injury to ligaments or TFCC.
• swelling, stiffness or pain that may be due to inflammation.
• clicks, locking or a feeling of instability in the wrist.
• suspected damage to tendons or tendon sheaths.
• suspected fracture or stress injury that is not clearly visible on a regular X-ray.
• suspected ganglion or other soft tissue changes.

MRI can also be used before treatment or surgery when there is a need to map the extent of an injury and its relationship to surrounding structures.

What can an MRI of the wrist show?

An MRI provides images in multiple planes and has high contrast between different soft tissues. This makes it possible to examine several of the wrist's small anatomical structures that can be difficult to assess with standard X-rays.

The examination can provide information about, among other things:

• the bones and bone marrow of the wrist.
• the scapholunate and lunotriquetral ligaments.
• TFCC, triangular fibrocartilaginous complex.
• tendons and tendon sheaths.
• articular cartilage and joint surfaces.
• synovial fluid and inflammatory changes.
• ganglion and other soft tissue changes.
• signs of hidden fracture or stress reaction in the skeleton.

Exactly what can be assessed depends on the question and which MRI protocol is used. In some specific questions, other examinations, such as ultrasound, computed tomography or MRI arthrography, may be more appropriate.

The image shows an example of an MRI image of the wrist. In the same examination, the radiologist can assess the small carpal bones, the lower part of the radius and ulna, as well as several of the wrist's ligaments and soft tissues. MRI can also show changes within the bone marrow that are not always visible on regular X-rays.

TFCC injury

TFCC, triangular fibrocartilage complex, is a complex of cartilage and ligament structures on the little finger side of the wrist. The structure contributes to the stability between the bones of the forearm and the wrist and also acts as a shock absorber during loading. TFCC can be damaged by, for example, falling on an outstretched hand, heavy rotation or repeated loading. Common symptoms are pain on the little finger side of the wrist, clicking, weakness when gripping and discomfort when twisting the forearm. MRI can be used to assess TFCC, but in certain cases, MRI arthrography or other complementary examination can provide additional information.

Ligament injuries and instability

The small carpal bones are held together by several ligaments. Two particularly important structures are the scapholunate ligament between the scaphoid and lunate and the lunotriquetral ligament between the lunate and triquetrum. Damage to these ligaments can lead to pain, clicking and instability and, in the long term, contribute to altered load and the development of osteoarthritis. MRI can show the ligaments themselves and provide information about the surrounding soft tissues and bone marrow, but the diagnosis may sometimes need to be supplemented depending on the type of injury.

Scaphoid fracture and hidden fractures

The scaphoid, or scaphoid, is one of the small carpal bones of the wrist and can be injured, for example, when falling on an outstretched hand. A scaphoid fracture can sometimes be difficult to see on the first X-ray examination. If clinical suspicion remains, MRI can be used to identify a fracture that is not visible on a regular X-ray.

MRI is sensitive to changes in the bone marrow and can therefore show both fractures and bone marrow edema. In the case of an already known navicular fracture, MRI or computed tomography can also be used for specific issues such as failure to heal or effects on the blood supply to the bone.

Tendons and tendon sheaths

A large number of flexor and extensor tendons pass through the wrist and enable movements in the hand, fingers and thumb. MRI can show changes in the tendons and tendon sheaths, such as inflammation, fluid accumulation, degenerative changes and certain tendon injuries. In de Quervain's disease, the tendon sheaths on the thumb side of the wrist are affected and typical symptoms are pain in the thumb and wrist, especially when gripping and moving. If there is a clear suspicion of superficial tendon problems, ultrasound can also be a very useful examination method.

Arthritis and inflammatory joint diseases

MRI can show changes in joint surfaces, bone marrow, synovial membrane and soft tissues and can therefore provide information in osteoarthritis and inflammatory joint diseases. In inflammatory arthritis, MRI can show synovitis, tenosynovitis, bone marrow edema and erosions. In contrast, regular X-rays are often used as an initial examination in suspected osteoarthritis or chronic joint disease. MRI is used primarily when more detailed information is needed or when symptoms and previous examinations do not match.

Ganglion in the wrist

A ganglion is a fluid-filled lesion that often occurs in connection with a joint or tendon sheath. Ganglions are common around the wrist and can be completely asymptomatic but can also cause pain, pressure or discomfort during movement. MRI can show the size and location of the lesion and its relationship to joints, ligaments, tendons and other surrounding structures. In many cases, a superficial ganglion can also be assessed with ultrasound.

Carpal Tunnel Syndrome and Nerve Impairment

Carpal tunnel syndrome is caused by pressure on the median nerve as it passes through the carpal tunnel in the wrist. Common symptoms include numbness, tingling, and sometimes pain in the thumb, index finger, middle finger, and parts of the ring finger.

MRI can show the median nerve and structures in the carpal tunnel but is not routinely used as a first-line examination for typical carpal tunnel syndrome. The diagnosis is based primarily on symptoms and clinical examination and can be supplemented with neurophysiological examination if necessary. MRI may be relevant when symptoms are atypical or when a structural cause of nerve damage needs to be ruled out.

How is a wrist MRI performed?

During the examination, the wrist is placed in a special coil that makes it possible to take detailed images of the relatively small anatomical area. Images and sequences are taken in several different planes so that the radiologist can assess the skeleton, joints, ligaments, tendons and soft tissues from different angles. The image below shows a different section through the wrist than the previous MRI image and illustrates how the same anatomical area can be examined from several directions for a more complete assessment.

The examination usually takes about 20 to 30 minutes. MRI does not use any X-ray radiation and the examination itself is painless, but it may be uncomfortable to lie still for a long time. In certain specific questions, contrast media may be needed, but many examinations of the wrist are performed without intravenous contrast media.

Book MRI wrist

After ordering, you will receive a call from one of our doctors who will review your medical history and your symptoms. A referral will then be sent directly to the X-ray clinic. MRI of the wrist may be particularly relevant in cases of long-term or difficult-to-assess wrist pain, suspected ligament or TFCC injury, tendon injury or when previous X-rays have not been able to explain the symptoms. The results are assessed by a radiologist and can then be used as a basis for further medical assessment and possible treatment. If you have problems primarily further out in the hand or fingers, an examination of the hand may be more relevant than an MRI of the wrist. Which area should be examined is determined by where the symptoms are located and which structure is suspected to be affected.