Soft Tissue Injuries of the Hand Guidelines

Updated: Nov 28, 2019
  • Author: Andrea B Lese, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Guidelines

Guidelines Summary

The American College of Radiology (ACR) guidelines for imaging acute hand and wrist trauma includes the following key recommendations [18] :

  • Radiographs of the area of interest are usually appropriate for the initial imaging of adults with acute blunt or penetrating trauma to the hand or wrist.
  • If initial radiographs are negative or equivocal, repeat radiographs in 10-14 days, MRI without IV contrast, or CT without IV contrast are usually appropriate as the next imaging study. 
  • If radiographs show acute wrist fracture and tendon or ligament trauma is suspected, MR arthrography of the wrist, MRI of the wrist without IV contrast, CT arthrography of the wrist, or ultrasonography of the wrist are usually appropriate as the next imaging study. 
  • If the initial radiographs show distal radioulnar joint or carpal malalignment in the absence of fracture, CT of both wrists without IV contrast, MRI of the wrist without IV contrast, or MR arthrography of the wrist are usually appropriate as the next imaging study.  
  • If radiographs show acute hand fracture and tendon or ligament trauma is suspected, MRI of the hand without IV contrast or ultrasonography of the hand are usually appropriate as the next imaging study.
  • If the initial radiographs show metacarpophalangeal, proximal interphalangeal, or distal interphalangeal joint malalignment in the absence of fracture, MRI of the hand without IV contrast, or ultrasonography of the hand, is usually appropriate as the next imaging study.