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Musculoskeletal ultrasound (MSUS) of paediatric wrists and hands can be a challenge due to age-specific physiological development and findings. MSUS of the hands and wrists is an important tool to diagnose inflammatory conditions, and the examiner must be highly knowledgeable about the normal age-related findings in these anatomic regions. This chapter covers the most important standard scans of paediatric wrists and hands and gives an overview of the normal paediatric sonoanatomy. In this chapter, basic pathologic findings are demonstrated by examples from paediatric rheumatology.

Ultrasound imaging guidance of needles introduced for the purpose of joint aspiration or joint injection is becoming increasingly popular. The use of ultrasound increases the safety and efficacy of joint injections in pediatric rheumatology. Needle guidance may be important for diagnostic purposes (fluid aspiration) as well as injections in juvenile idiopathic arthritis (JIA) for short-term relief via intraarticular corticosteroid (CS) injections or longer-term management of limited disease and treatment-resistant multi-joint disease. Ultrasound guidance can also be used to inject steroids into tendon sheaths or around entheses in inflammatory conditions. The following chapter gives an overview of typical indications for ultrasound-guided intraarticular injections in pediatric rheumatology and describes the procedures used for ultrasound guidance of CS injections in specific anatomic regions.