High-Resolution US of the Radial Wrist: Anatomy, Variants, and Clinical Correlates.

US has emerged as a valuable imaging tool for evaluating musculoskeletal abnormalities, including radial wrist conditions. It offers high-resolution real-time assessment of joints, ligaments, tendons, nerves, and other soft-tissue structures in the region. Yet, the complex anatomy of the wrist, frequent anatomic variants, and often nonspecific clinical symptoms present substantial challenges for the clinician and the US practitioner alike. This comprehensive review provides a structured and practical approach to US evaluation of the radial wrist, designed to enhance diagnostic confidence and accuracy for radiologists, sonographers, clinicians, and trainees. An in-depth anatomic overview of the radial wrist is presented, with particular emphasis on the joint articulations, extensor and flexor tendons, and neurovascular structures encountered in this segment of the wrist. Normal US anatomy, anatomic variants, and abnormalities including arthritides, ligament injuries, tendinopathies, and nerve entrapment are illustrated, with imaging examples and schematic diagrams. Emphasis is placed on optimization of technique, use of dynamic assessment, and correlation with clinical symptoms. Common diagnostic challenges are highlighted, and techniques for US-guided interventions are discussed. With its ability to allow direct visualization of abnormalities and guidance of procedures, US is integral to the diagnosis and management of radial wrist disorders. The authors highlight the importance of anatomic knowledge, precise scanning technique, and thoughtful clinical correlation to maximize the diagnostic value of US in this complex region, ultimately improving patient outcomes. ©RSNA, 2026 Supplemental material is available for this article.