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Semin Musculoskelet Radiol 2023; 27(02): 169-181
DOI: 10.1055/s-0043-1761953
Review Article

Imaging of Anatomical Variants Around the Wrist and Hand

Federico Zaottini
1   Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
,
Riccardo Picasso 
1   Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
,
Federico Pistoia
2   Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
,
Michelle Pansecchi
3   Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
,
Luca Tovt
3   Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
,
Marta Macciò
3   Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
,
Sara Sanguinetti
2   Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
,
Carlo Martinoli 
1   Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
3   Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Abstract

Wrist and hand anatomy may present several clinically relevant variants that involve bones, muscles, tendons, and nerves. Thorough knowledge of these abnormalities and their appearance in imaging studies is useful for proper management. In particular, it is necessary to differentiate the incidental findings that do not represent a trigger for a specific syndrome from those anomalies causing symptoms and functional impairment. This review reports the most common anatomical variants encountered in clinical practice and briefly discusses their embryogenesis, related clinical syndrome if present, and their appearance using different imaging techniques. The information each diagnostic study (ultrasonography, radiographs, computed tomography, and magnetic resonance imaging) may provide is described for each condition.

Keywords

anatomical variants - wrist - magnetic resonance imaging - plain radiography - ultrasonography


Publication History

Article published online:
03 April 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. Eur Radiol 2018; 28 (10) 4182-4194
    CrossrefPubMedGoogle Scholar
  • 2 Mespreuve M, Bosmans F, Waked K, Vanhoenacker FM. Hand and wrist: a kaleidoscopic view of accessory ossicles, variants, coalitions, and others. Semin Musculoskelet Radiol 2019; 23 (05) 511-522
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Defazio MV, Cousins BJ, Miversuski Jr RA, Cardoso R. Carpal coalition: a review of current knowledge and report of a single institution's experience with asymptomatic intercarpal fusion. Hand (N Y) 2013; 8 (02) 157-163
    CrossrefPubMedGoogle Scholar
  • 4 Burnett SE. Hamate-pisiform coalition: morphology, clinical significance, and a simplified classification scheme for carpal coalition. Clin Anat 2011; 24 (02) 188-196
    CrossrefPubMedGoogle Scholar
  • 5 Resnik CS, Grizzard JD, Simmons BP, Yaghmai I. Incomplete carpal coalition. AJR Am J Roentgenol 1986; 147 (02) 301-304
    CrossrefPubMedGoogle Scholar
  • 6 Devilliers Minnaar AB. Congenital fusion of the lunate and triquetral bones in the South African Bantu. J Bone Joint Surg Br 1952; 34-B (01) 45-48
    CrossrefPubMedGoogle Scholar
  • 7 Gottschalk MB, Danilevich M, Gottschalk HP. Carpal coalitions and metacarpal synostoses: a review. Hand (N Y) 2016; 11 (03) 271-277
    CrossrefPubMedGoogle Scholar
  • 8 Alemohammad AM, Nakamura K, El-Sheneway M, Viegas SF. Incidence of carpal boss and osseous coalition: an anatomic study. J Hand Surg Am 2009; 34 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 9 Conway WF, Destouet JM, Gilula LA, Bellinghausen HW, Weeks PM. The carpal boss: an overview of radiographic evaluation. Radiology 1985; 156 (01) 29-31
    CrossrefPubMedGoogle Scholar
  • 10 Nakamura K, Patterson RM, Viegas SF. The ligament and skeletal anatomy of the second through fifth carpometacarpal joints and adjacent structures. J Hand Surg Am 2001; 26 (06) 1016-1029
    CrossrefPubMedGoogle Scholar
  • 11 Goiney C, Porrino J, Richardson ML, Mulcahy H, Chew FS. Characterization and epidemiology of the carpal boss utilizing computed tomography. J Wrist Surg 2017; 6 (01) 22-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Henry A, Thorburn MJ. Madelung's deformity. A clinical and cytogenetic study. J Bone Joint Surg Br 1967; 49 (01) 66-73
    CrossrefPubMedGoogle Scholar
  • 13 Anton JI, Reitz GB, Spiegel MB. Madelung's deformity. Ann Surg 1938; 108 (03) 411-439
    CrossrefPubMedGoogle Scholar
  • 14 Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg [Br] 1992; 17 (04) 401-407
    CrossrefPubMedGoogle Scholar
  • 15 Knutsen EJ, Goldfarb CA. Madelung's deformity. Hand (N Y) 2014; 9 (03) 289-291
    CrossrefPubMedGoogle Scholar
  • 16 Felman AH, Kirkpatrick Jr JA. Madelung's deformity: observations in 17 patients. Radiology 1969; 93 (05) 1037-1042
    Google Scholar
  • 17 Ali S, Kaplan S, Kaufman T, Fenerty S, Kozin S, Zlotolow DA. Madelung deformity and Madelung-type deformities: a review of the clinical and radiological characteristics. Pediatr Radiol 2015; 45 (12) 1856-1863
    CrossrefPubMedGoogle Scholar
  • 18 Jebson PJ, Blair WF. Bilateral spontaneous extensor tendon ruptures in Madelung's deformity. J Hand Surg Am 1992; 17 (02) 277-280
    CrossrefPubMedGoogle Scholar
  • 19 Rondier J, Cirotteau Y, Efthymiou T, Premont M. Maladie de Madelung et lésions des tendons extenseurs. A propos d'une observation [in French]. Rev Chir Orthop Repar Appar Mot 1990; 76 (03) 204-208
    PubMedGoogle Scholar
  • 20 Zebala LP, Manske PR, Goldfarb CA. Madelung's deformity: a spectrum of presentation. J Hand Surg Am 2007; 32 (09) 1393-1401
    CrossrefPubMedGoogle Scholar
  • 21 Rajput R, Bhat RV, Bhansali A. Reverse Madelung deformity. J Assoc Physicians India 2005; 53: 120
    PubMedGoogle Scholar
  • 22 Timins ME. Osseous anatomic variants of the wrist: findings on MR imaging. AJR Am J Roentgenol 1999; 173 (02) 339-344
    CrossrefPubMedGoogle Scholar
  • 23 Taleisnik J. The ligaments of the wrist. J Hand Surg Am 1976; 1 (02) 110-118
    CrossrefPubMedGoogle Scholar
  • 24 Mauler F, Rahm S, Schweizer A, Nagy L. Bilateral symptomatic os epilunatum: a case report. J Wrist Surg 2015; 4 (01) 68-70
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Greene MH, Hadied AM. Bipartite hamulus with ulnar tunnel syndrome—case report and literature review. J Hand Surg Am 1981; 6 (06) 605-609
    CrossrefPubMedGoogle Scholar
  • 26 Mespreuve M, Vanhoenacker F, Verstraete K. Imaging findings of the distal radio-ulnar joint in trauma. J Belg Soc Radiol 2015; 99 (01) 1-20
    CrossrefPubMedGoogle Scholar
  • 27 Nakamura R, Tanaka Y, Imaeda T, Miura T. The influence of age and sex on ulnar variance. J Hand Surg [Br] 1991; 16 (01) 84-88
    CrossrefPubMedGoogle Scholar
  • 28 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology 1996; 201 (02) 495-500
    CrossrefPubMedGoogle Scholar
  • 29 van Leeuwen WF, Oflazoglu K, Menendez ME, Ring D. Negative ulnar variance and Kienböck disease. J Hand Surg Am 2016; 41 (02) 214-218
    CrossrefPubMedGoogle Scholar
  • 30 Rodríguez-Niedenführ M, Vázquez T, Golanó P, Parkin I, Sañudo JR. Extensor digitorum brevis manus: anatomical, radiological and clinical relevance. A review. Clin Anat 2002; 15 (04) 286-292
    CrossrefPubMedGoogle Scholar
  • 31 Ouellette H, Thomas BJ, Torriani M. Using dynamic sonography to diagnose extensor digitorum brevis manus. AJR Am J Roentgenol 2003; 181 (05) 1224-1226
    CrossrefPubMedGoogle Scholar
  • 32 Martinoli C, Perez MM, Padua L. et al. Muscle variants of the upper and lower limb (with anatomical correlation). Semin Musculoskelet Radiol 2010; 14 (02) 106-121
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Linburg RM, Comstock BE. Anomalous tendon slips from the flexor pollicis longus to the flexor digitorum profundus. J Hand Surg Am 1979; 4 (01) 79-83
    CrossrefPubMedGoogle Scholar
  • 34 Yurasakpong L, Meemon K, Suwannakhan A. Linburg-Comstock variation: histoanatomy and classification of the connection between flexor pollicis longus and flexor digitorum profundus to the index finger. Surg Radiol Anat 2018; 40 (03) 297-301
    CrossrefPubMedGoogle Scholar
  • 35 Miller G, Peck F, Brain A, Watson S. Musculotendinous anomalies in musician and nonmusician hands. Plast Reconstr Surg 2003; 112 (07) 1815-1822 ; discussion 1823–1824
    CrossrefPubMedGoogle Scholar
  • 36 Slater RR. Flexor tendon anomalies in a patient with carpal tunnel syndrome. J Hand Surg [Br] 2001; 26 (04) 373-376
    CrossrefPubMedGoogle Scholar
  • 37 Karalezli N, Karakose S, Haykir R, Yagisan N, Kacira B, Tuncay I. Linburg-Comstock anomaly in musicians. J Plast Reconstr Aesthet Surg 2006; 59 (07) 768-771
    CrossrefPubMedGoogle Scholar
  • 38 Zeiss J, Guilliam-Haidet L. MR demonstration of anomalous muscles about the volar aspect of the wrist and forearm. Clin Imaging 1996; 20 (03) 219-221
    CrossrefPubMedGoogle Scholar
  • 39 Rixey A, Wenger D, Baffour F, Kakar S, McKenzie G. Accessory abductor digiti minimi muscle, less muscular than thought: an update on prevalence, morphology, and review of the literature. Skeletal Radiol 2021; 50 (08) 1687-1695
    CrossrefPubMedGoogle Scholar
  • 40 Siegel DB, Kuzma G, Eakins D. Anatomic investigation of the role of the lumbrical muscles in carpal tunnel syndrome. J Hand Surg Am 1995; 20 (05) 860-863
    CrossrefPubMedGoogle Scholar
  • 41 Parminder K. Morphological study of lumbricals—a cadaveric study. J Clin Diagn Res 2013; 7 (08) 1558-1560
    PubMedGoogle Scholar
  • 42 Ioannis D, Anastasios K, Konstantinos N, Lazaros K, Georgios N. Palmaris longus muscle's prevalence in different nations and interesting anatomical variations: review of the literature. J Clin Med Res 2015; 7 (11) 825-830
    CrossrefPubMedGoogle Scholar
  • 43 Zeybek A, Gürünlüoglu R, Cavdar S, Bayramiçli M. A clinical reminder: a palmaris longus muscle variation. Ann Plast Surg 1998; 41 (02) 224-225
    CrossrefPubMedGoogle Scholar
  • 44 Olewnik Ł, Wysiadecki G, Polguj M, Podgórski M, Jezierski H, Topol M. Anatomical variations of the palmaris longus muscle including its relation to the median nerve—a proposal for a new classification. BMC Musculoskelet Disord 2017; 18 (01) 539
    CrossrefPubMedGoogle Scholar
  • 45 Stecco C, Lancerotto L, Porzionato A. et al. The palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis. Clin Anat 2009; 22 (02) 221-229
    CrossrefPubMedGoogle Scholar
  • 46 Keese GR, Wongworawat MD, Frykman G. The clinical significance of the palmaris longus tendon in the pathophysiology of carpal tunnel syndrome. J Hand Surg [Br] 2006; 31 (06) 657-660
    CrossrefPubMedGoogle Scholar
  • 47 Pirola E, Hébert-Blouin MN, Amador N, Amrami KK, Spinner RJ. Palmaris profundus: one name, several subtypes, and a shared potential for nerve compression. Clin Anat 2009; 22 (06) 643-648
    CrossrefPubMedGoogle Scholar
  • 48 Sahinoglu K, Cassell MD, Miyauchi R, Bergman RA. Musculus comitans nervi mediani (M. palmaris profundus). Ann Anat 1994; 176 (03) 229-232
    CrossrefPubMedGoogle Scholar
  • 49 Neumeister MW, Mowlavi A, Russell RC, Wilhelmi BJ. Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome. Can J Plast Surg 2005; 13 (01) 27-30
    CrossrefPubMedGoogle Scholar
  • 50 Elliot D, Khandwala AR, Kulkarni M. Anomalies of the flexor digitorum superficialis muscle. J Hand Surg [Br] 1999; 24 (05) 570-574
    CrossrefPubMedGoogle Scholar
  • 51 Bhat W, Davis CR, Akali A, Kay SP, Roberts AM. Painful, palpable and pathological: anomalous flexor digitorum superficialis brevis in the palm, comparative anatomical context, and an updated classification of anomalies of the flexor digitorum superficialis. J Hand Surg Eur Vol 2014; 39 (01) 101-106
    CrossrefPubMedGoogle Scholar
  • 52 Nischal N, Gupta S, Lal K, Singh JP. Performance evaluation of high-resolution ultrasound versus magnetic resonance imaging in diagnosing peripheral nerve pathologies. Indian J Radiol Imaging 2021; 31 (01) 43-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 1977; 2 (01) 44-53
    CrossrefPubMedGoogle Scholar
  • 54 Henry BM, Zwinczewska H, Roy J. et al. The prevalence of anatomical variations of the median nerve in the carpal tunnel: a systematic review and meta-analysis. PLoS One 2015; 10 (08) e0136477
    CrossrefPubMedGoogle Scholar
  • 55 Natsis K, Iordache G, Gigis I. et al. Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature. Folia Morphol (Warsz) 2009; 68 (04) 193-200
    PubMedGoogle Scholar
  • 56 Hanna AS, Wei Z, Hanna BA. Median nerve variation: a complete spin before terminal branching. J Brachial Plex Peripher Nerve Inj 2020; 15 (01) e1-e4
    Article in Thieme ConnectPubMedGoogle Scholar
  • 57 Lis M, Solewski B, Koziej M, Walocha E, Walocha JA, Klimek-Piotrowska W. The median nerve penetrating through the radial head of the flexor digitorum superficialis muscle: case report. Folia Med Cracov 2018; 58 (01) 107-111
    PubMedGoogle Scholar
  • 58 Bezerra AJ, Carvalho VC, Nucci A. An anatomical study of the palmar cutaneous branch of the median nerve. Surg Radiol Anat 1986; 8 (03) 183-188
    CrossrefPubMedGoogle Scholar
  • 59 DaSilva MF, Moore DC, Weiss AP, Akelman E, Sikirica M. Anatomy of the palmar cutaneous branch of the median nerve: clinical significance. J Hand Surg Am 1996; 21 (04) 639-643
    CrossrefPubMedGoogle Scholar