In the evaluation of the TFCC, it is important not only to assess the articular disc, but also the volar radioulnar ligament, and the dorsal radioulnar ligament which can be seen on volar and dorsal coronal images, as well as sagittal images. The articular disc is seen on central coronal images, and also seen on the central portion of the sagittal images. The TFC may be seen on axial images with its volar and dorsal radioulnar ligament attachments. The TFCC refers to the triangular fibrocartilage and any additional ulnar ligamentous structures, such as the meniscus homologue, ulnar collateral ligaments, subsheath of the extensor carpi ulnaris tendon, and the ulnolunate and the ulnotriquetral ligaments.

The ulnocarpal ligament group, consisting of the ulnolunate, and ulnotriquetral ligaments, which extend from the volar aspect of the volar radioulnar ligament to the lunate and triquetrum, are best evaluated on volar coronal images. Disruption, or fluid intensity from synovitis can be identified on MR images. The TFC can be classified as either a degenerative TFC lesion or a traumatic TFC lesion using the Palmer classification system. Degenerative lesions are usually associated with TFC wear plus chondromalacia of either the lunate and/or triquetrum.

Ulnar styloid fractures should be evaluated as to whether they are proximal or distal. Proximal fractures are usually associated with a component of radioulnar instability. In pronation, the dorsal radioulnar ligament is taut, whereas, in supination, the volar radioulnar ligament is taut. These are stabilizing forces on the distal radioulnar joint. Positive ulnar variance may be associated with ulnar impaction syndrome in which case, there is subchondral sclerosis, eccentrically located on the ulnar aspect of the lunate. This should not be mistaken for Kienbock's disease. There may be subchondral sclerosis on the adjacent portion of the triquetrum. This syndrome is also associated with tears of the TFCC as well as lunotriquetral ligament.

In evaluating fractures of the distal radius, the Malone classification system which divides fractures into the metaphysial (shaft) component, radial styloid, dorsal medial or palmar medial component should be used. Kienbock's disease can be evaluated using MRI, and classified in MR equivalents of Stages I through IV. MRI is most useful in early stages of Kienbock's disease before there is subchondral collapse.

Carpal tunnel syndrome can be evaluated using MRI, however, MRI is most useful for identifying space-occupying lesions or gross tenosynovitis. Morphology of the lunate should be assessed with respect to the medial lunate facete variant which may be associated with arthritis between the lunate and the capitate or the lunate and the hamate. SLAC or scapholunate advanced collapse represents the most common form of arthritis in the wrist and involves degeneration of proximal scaphoradial articulation, capitolunate articular destruction, destruction of the scaphoradial, capitolunate, and/or scaphocapitate joints. The capitate may inpinge on the radius. Degenerative disorders of the carpus include both the SLAC wrist which is the most common form of degenerative carpal disease, followed by triscaphe arthritis.

MRI of the wrist and hand is also useful in the evaluation of the Stenner lesion in which the ulnar collateral ligament is retracted and prolapsed outside the adductor pollicis aponeurosis. This ruptures usually distally. It is important to distinguish the position of the ulnar collateral ligament versus the aponeurosis itself. Tenosynovitis outside the carpal tunnel can be evaluated in areas such as DeQuervain's tenosynovitis which involves the first extensor compartment, consisting of the abductor pollicis longus, and extensor pollicis brevis.

Carpal instabilities of the wrist can be divided into dynamic and static instability patterns clinically. On MRI, DISI and VISI instability patterns can be evaluated by assessing the position of the lunate relative to the capitate provided that the wrist is not in ulnar deviation or radial deviation when imaged.