USMSIT/NMUSIT Fundamental Guide on Diagnostic and Interventional Wrist/Hand Ultrasonography

Wrist and hand disorders are among the common musculoskeletal complaints, with high-resolution ultrasonography now regarded as an indispensable tool for their evaluation and management. Building upon the EURO-MUSCULUS/USPRM framework and the educational principles of the Ultrasound Musculoskeletal Workshop in Taiwan and the Neuromuscular Ultrasound Workshop in Taiwan programs, this guideline provides a standardized, anatomy-based approach to diagnostic and interventional ultrasound (US) of the wrist and hand. The protocol outlines systematic scanning of the six extensor compartments, scapholunate ligament, triangular fibrocartilage complex, carpal tunnel, Guyon's canal, A1 pulley, and digital collateral ligaments. It also integrates patient positioning, transducer orientation, and dynamic maneuvers to optimize visualization. Tripartite visual documentation, comprising cadaveric dissections, schematic anatomical illustrations, and paired US images from both high-end and handheld devices, supports reproducible interpretation. Common pathologies - including De Quervain tenosynovitis, scapholunate ligament injuries, triangular fibrocartilage complex disorders, trigger finger and trigger thumb, and carpal tunnel syndrome - are characterized with their key sonographic features and functional correlates. Practical pearls for US-guided interventions are outlined for De Quervain tenosynovitis, scapholunate joint, A1 pulley, and carpal tunnel. Emphasizing the principle of "diagnosis ahead of intervention"; this guideline aims to enhance consistency, safety, and clinical effectiveness in the US-based assessment, diagnosis, and treatment of wrist and hand disorders. It provides an image-anatomy framework suitable for future integration into artificial intelligence-assisted systems as well.