Initial Workup for Numbness in the Wrist

Clinical Evaluation and Imaging

Radiographs are the most appropriate initial imaging study for evaluating numbness in the wrist, as they can establish specific diagnoses in many cases including arthritis, complications of injury, and other structural abnormalities, according to the American College of Radiology 1
Standard radiographic examination should include posterior-anterior and lateral views in neutral position, supplemented by one or more oblique views, as recommended by the American College of Radiology 1
Radiographs can identify bony abnormalities that may cause nerve compression, such as fractures, arthritis, or anatomical variants, as stated by the Journal of the American College of Radiology 2

If radiographs are normal or nonspecific and symptoms persist, MRI without IV contrast is usually appropriate as the next study, according to the Journal of the American College of Radiology 2, 3
MRI without IV contrast accurately depicts abnormalities of bones, bone marrow, articular cartilage, ligaments, TFCC, synovium, tendons, and neurovascular structures that may contribute to numbness, as reported by the Journal of the American College of Radiology 3
Ultrasound is particularly useful for examining extra-articular soft tissues and can identify nerve compression, especially for carpal tunnel syndrome, as noted by the American College of Radiology and Praxis Medical Insights 1, 3
Ultrasound is a validated technique for measuring median nerve size in carpal tunnel syndrome, with increased cross-sectional area being diagnostic, according to Praxis Medical Insights 1

For radial nerve distribution numbness, consider radial nerve compression or De Quervain tenosynovitis, as suggested by Praxis Medical Insights 1