Ultrasound of the palmar aspect of the hand: normal anatomy and clinical applications of intrinsic muscles imaging

Riccardo Picasso1, Federico Zaottini1, Federico Pistoia1, Maribel Miguel Perez2, Marta Macciò3, Deborah Bianco3, Simone Rinaldi3, Michelle Pansecchi3, Gabriele Rossi3, Luca Tovt3, Carlo Martinoli1,3

Affiliation and address for correspondence
J Ultrason 2023;23: e122–e130
DOI: 10.15557/JoU.2023.0021
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Intrinsic hand muscles play a fundamental role in tuning the fine motricity of the hand and may be affected by several pathologic conditions, including traumatic injuries, atrophic changes induced by denervation, and space-occupying masses. Modern hand surgery techniques allow to target several hand muscle pathologies and, as a direct consequence, requests for hand imaging now carry increasingly complex diagnostic questions. The progressive refinement of ultrasound technology and the current availability of high and ultra-high frequency linear transducers that allow the investigation of intrinsic hand muscles and tendons with incomparable resolution have made this modality an essential tool for the evaluation of pathological processes involving these tiny structures. Indeed, intrinsic hand muscles lie in a superficial position and are amenable to investigation by means of transducers with frequency bands superior to 20 MHz, offering clear advantages in terms of resolution and costs compared to magnetic resonance imaging. In addition, ultrasound allows to perform dynamic maneuvers that can critically enhance its diagnostic power, by examining the questioned structure during stress tests that simulate the conditions eliciting clinical symptoms. The present article aims to review the anatomy, the ultrasound scanning technique, and the clinical application of thenar, hypothenar, lumbricals and interossei muscles imaging, also showing some examples of pathology involving these structures.

hand imaging; ultrasound; thenar; hypothenar; lumbricals