High-Resolution Sonography in the Evaluation of Non-Traumatic Wrist Pain: A Prospective Observational Study

Background: Non-traumatic wrist pain is a common clinical presentation with a broad differential diagnosis. High-resolution ultrasound (HRUS) provides a rapid, non-invasive method for evaluating soft tissue and joint pathologies in the wrist. Objective: To evaluate the diagnostic role of high-resolution sonography in identifying the etiologies of non-traumatic wrist pain in adults. Methods: A prospective observational study was conducted on 124 adult patients presenting with non-traumatic wrist pain. Grayscale and Doppler HRUS examinations were performed to identify synovitis, tenosynovitis, ganglia, erosions, osteophytes, and median nerve abnormalities. Both dorsal and volar scanning planes were used. Data were analyzed for prevalence of findings, correlation with clinical diagnoses and pain patterns, and diagnostic yield of scanning approaches. Results: Synovitis (66.9%), extensor tenosynovitis (62.9%), and effusion (52.4%) were the most prevalent abnormalities. Ganglia were noted in 18.5%, while median nerve thickening was present in 10.5% of patients. Dorsal views were more sensitive than volar views for detecting inflammatory changes. The most common clinical diagnosis was rheumatoid arthritis (31.5%), followed by degenerative arthritis and mechanical wrist pain. Inflammatory pain correlated with synovitis and tenosynovitis, while mechanical pain was associated with ganglia and osteophytes. Conclusion: HRUS is a valuable first-line imaging tool for non-traumatic wrist pain, providing detailed soft tissue assessment and aiding in early diagnosis. The dorsal approach enhances lesion detection and should be included in standard wrist sonographic evaluation protocols.