Synovial inflammatory processes in the hand

The numerous synovial articulations and tendon sheaths of the hand afford it a central role in the diagnosis and management of inflammatory arthropathies. Inflammation may be idiopathic, infectious, post-traumatic, or secondary to deposition diseases. In most cases, synovial inflammation represents the primal event in the onset of destructive arthropathies. We review the imaging features of acute and chronic synovitis in the hand. Magnetic resonance imaging is very sensitive to the earliest changes of synovitis and provides a modality for early detection of disease. Additionally, once a diagnosis is established, magnetic resonance imaging has an emerging role in rapid assessment of response to therapy. Positron emission tomography and ultrasound also show promise in the evaluation and treatment of inflammatory arthropathies. Although highly sensitive to the presence of inflammation these more advanced imaging techniques often lack specificity. Therefore, the radiographic evaluation of the pattern of bone destruction remains critical to distinguishing among the different synovial inflammatory processes.