Seek urgent medical assessment rather than booking a scan if you have: wrist or hand pain immediately after a fall or significant injury, especially with deformity or inability to move the joint; a hot, red, swollen joint with fever; wasting of the muscle at the base of the thumb; or numbness and weakness that is getting rapidly worse. A suspected scaphoid fracture needs an X-ray, not an ultrasound.
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Wrist and hand pain has a wide range of causes, and they are distinguished mostly by where it hurts and what brings it on. Ultrasound is well suited to this region because the structures sit close to the surface and can be watched while the joint moves. It assesses tendons, nerves, cysts and joint lining accurately — but it does not image bone well, so a suspected fracture needs an X-ray instead.
| Condition | Where it typically hurts | Classic trigger |
|---|---|---|
| Carpal tunnel syndrome | Palm side of the wrist, with numbness in thumb, index, middle and half the ring finger | Worse at night; shaking the hand helps |
| De Quervain’s tenosynovitis | Thumb side of the wrist | Gripping, lifting, wringing; common after a new baby |
| Trigger finger | Base of a finger on the palm side | Finger catches or locks, worse in the morning |
| Thumb base osteoarthritis | Base of the thumb | Pinching, opening jars, turning keys |
| Ganglion cyst | Back or front of the wrist | A visible lump that may change in size |
| Wrist tendinopathy | Follows the line of the affected tendon | Repetitive loading, new training or work task |
The carpal tunnel is a narrow passage on the palm side of the wrist. The median nerve runs through it alongside the tendons that bend the fingers. When pressure builds inside that tunnel, the nerve is compressed.
The pattern is distinctive: numbness, tingling or burning in the thumb, index, middle and the thumb-side half of the ring finger. The little finger is spared, because it is supplied by a different nerve. Symptoms are usually worse at night and often wake people, and many find that shaking the hand brings relief. In longer-standing cases the muscle bulk at the base of the thumb wastes and grip weakens.
Diagnosis is primarily clinical. Nerve conduction studies remain the standard confirmatory test. Ultrasound has a supporting role: it measures the cross-sectional area of the median nerve, which enlarges just before it enters the tunnel when the nerve is compressed, and it can show a cause such as thickened tendon sheaths, a cyst or an unusual anatomical variant. It is not a substitute for nerve conduction studies where those are indicated.
De Quervain’s tenosynovitis affects two tendons running along the thumb side of the wrist, where they pass through a tight tunnel. It causes pain on gripping, lifting and wringing, and is common in new parents and in anyone who has recently increased repetitive thumb use. Ultrasound shows fluid and thickening around the tendon sheath, and can identify a small dividing wall within the compartment that makes some cases harder to treat.
Trigger finger occurs when a flexor tendon thickens where it passes under a restraining pulley at the base of the finger, so the tendon catches as it glides. The finger clicks, locks, or has to be straightened with the other hand. Ultrasound shows the thickened pulley and tendon, and — usefully — lets the sonographer watch the catching happen in real time.
The same tendinopathy reasoning applies elsewhere in the body. Our guides to tennis elbow versus golfer’s elbow and Achilles tendon pain cover the same distinction between a degenerate tendon and a torn one.
A ganglion is a fluid-filled sac arising from a joint or tendon sheath, most often on the back of the wrist. They are benign. They can change in size, sometimes disappear on their own, and are often painless — though they can ache or press on nearby structures.
Ultrasound is a good first test for a wrist or hand lump. It distinguishes a fluid-filled cyst from a solid lump quickly, shows the connection to the joint or tendon sheath, and can guide aspiration if that is planned. Where a lump is solid, growing, or has other concerning features, further imaging or a specialist opinion is needed rather than reassurance from ultrasound alone.
Ultrasound is a strong test in this region, and being clear about its edges makes it more useful, not less.
It assesses well: tendons and their sheaths, the median and ulnar nerves, ganglion cysts and soft-tissue lumps, joint lining and fluid, and active inflammation using Doppler. It also allows dynamic assessment — watching a tendon catch or a lump move — and easy comparison with the other side.
It does not assess well: bone. Ultrasound cannot reliably exclude a fracture, and a suspected scaphoid injury after a fall on the outstretched hand needs an X-ray, sometimes followed by MRI or CT. It also cannot see the small cartilage structure at the little-finger side of the wrist — the TFCC — which usually needs MRI. Deep ligaments between the small wrist bones are similarly better assessed by MRI arthrography.
Our guide to MSK ultrasound sets out how ultrasound compares with MRI and X-ray across the body.
The thumb side of the wrist. Scan-wise we are separating tendon from joint. De Quervain’s shows a thickened, inflamed tendon sheath in the first dorsal compartment, often with fluid and Doppler activity along the tendon. Thumb base arthritis shows something different — joint-space narrowing, osteophytes and synovitis centred on the first carpometacarpal joint. Ultrasound overturns the initial label surprisingly often: what was assumed to be De Quervain’s proves to be CMC arthritis, or the other way round, and sometimes the scan shows both processes are in play at once.
When the answer is an X-ray, not a scan. We routinely see people booking a wrist ultrasound when the right first test is an X-ray. The trigger is usually the story rather than anything on the images: a fall onto an outstretched hand, very focal bony tenderness over the distal radius or scaphoid, a pattern that fits a possible fracture far better than a soft-tissue injury. Ultrasound will show the swelling, but it cannot reliably exclude a break. The honest line is that this mechanism and tenderness pattern are more worryingly bony, and an X-ray or cross-sectional imaging is the appropriate next step.
Carpal tunnel. We are explicit about the division of labour. The diagnosis is clinical, and nerve conduction studies are what grade severity. Ultrasound is there to look at anatomy: median nerve swelling or flattening, bowing of the flexor retinaculum, or a ganglion or aberrant muscle compressing the nerve — and sometimes to reassure when the nerve looks entirely normal. What we do not claim is that a scan replaces nerve conduction studies. It refines the picture and rules out structural causes; it does not tell you how damaged the nerve is.
Lumps. Most turn out to be straightforward ganglion cysts, which are thought to account for roughly two-thirds of soft-tissue masses in the hand and wrist. On scan they are well-defined, cystic and non-vascular, and those are the cases where we can confidently reassure. Escalation comes when a lump looks solid or mixed rather than purely cystic, shows internal blood flow, has irregular borders, or seems to invade adjacent structures. That is when the report shifts from a typical ganglion to one needing further imaging or specialist review — because not every bump is benign.
Describes general patterns across the patients we scan, not any individual case.
Activity modification and splinting. A night splint holding the wrist straight is a well-established first step for carpal tunnel syndrome. A thumb spica splint is used for De Quervain’s and thumb base arthritis.
Hand therapy. A hand therapist or physiotherapist can provide tendon gliding exercises, grip retraining, and advice on adapting work tasks.
Injections. A corticosteroid injection can be effective for carpal tunnel syndrome, De Quervain’s and trigger finger. Image guidance improves placement accuracy in these small compartments — see ultrasound-guided injections. Our ultrasound-guided injections start from £250.
Surgery. Considered where symptoms persist despite conservative treatment, or where there is nerve damage with muscle wasting. Carpal tunnel release and trigger finger release are both common day-case procedures.
It supports the diagnosis rather than making it. Ultrasound measures the median nerve and can show a structural cause of compression, but the diagnosis is primarily clinical and nerve conduction studies remain the standard confirmatory test.
No. Ultrasound does not image bone reliably and cannot exclude a fracture. A painful wrist after a fall needs an X-ray first — particularly if the pain is at the thumb side, where a scaphoid fracture can be easily missed.
Most wrist lumps are ganglion cysts, which are benign. Ultrasound distinguishes a fluid-filled cyst from a solid lump quickly. A lump that is solid, enlarging or painful warrants a specialist opinion rather than reassurance from a scan alone.
Night-time numbness in the thumb, index, middle and half the ring finger is the classic pattern of carpal tunnel syndrome, and shaking the hand often relieves it. See your GP if it is persistent, and urgently if you notice weakness or thumb muscle wasting.
No. You can book a wrist or hand ultrasound directly with us. If your symptoms suggest a fracture or a nerve problem needing conduction studies, we will tell you and point you to the right test rather than scanning for the sake of it.
A wrist or hand ultrasound is £235. You receive instant verbal results at the appointment from the consultant performing your scan, with the written report following within 24 hours.
More detail on each service: wrist ultrasound, hand ultrasound, or the full range of MSK ultrasound scans.
CQC-registered clinic · HCPC-registered sonographers · BMUS member · ICO-registered. Reports can be shared securely with your NHS GP or specialist at your request.
